HL7® FHIR®– what is it and why we need it?

By: Amos (Kippi) Bordowitz


To read this post in Hebrew, click here

Our world is an interconnected one. 

Our data is between many systems and organizations, seemingly seamlessly, and hopefully without problems and mistakes or data leaks. While this is true in many fields, in one case there is a glaring problem – healthcare. Even though all data collected by healthcare organizations is digital, there is no standard way of saving data. This may lead to a whole host of problems, which we will try to demonstrate.

Imagine the following case: a patient (Let us call her Carol) had undergone major heart surgery 5 years ago in her local hospital. Meanwhile, Carol has moved to a new city. One evening, she feels chest pains and is rushed to a new hospital. To give Carol the best treatment, the staff must know what was performed on her 5 years prior. So, the hospital makes a request to the previous hospital for all the pertinent records. The problem is that there is no basic agreement between the hospitals on how the data should be maintained and shared – every datum is saved just a little differently than the way the new hospital does it – from the way personal information is coded to the units of medication given. The new hospital now must allocate resources and waste time deciphering the information. This slows down the time it would take to get the essential information to treat Carol, which might cost her her life.

What did we have until now?

Previous attempts have been made to standardize the flow of information in healthcare. The most well-known is HL7 V2, a message-based standard. It was customizable and flexible but lacked many important properties to make it truly interoperable (interoperability is the ability of systems to exchange and make use of the exchanged information). It’s biggest problem, aside from the outdated technology, was the fact that both organizations had to agree on the same “rules” of how the data is transferred so true and open interoperability was hard to achieve.

Enter FHIR. FHIR standardizes the formats of data exchanged between a whole range of organizations, so that no matter what Electronic Medical Record (EMR) system, admission-discharge-transfer (ADT) system or database is under the hood, to the outside world it all looks exactly the same. This allows for better interoperability between both hospitals (and any other organization), saving money, but perhaps even more importantly, time.

FHIR, therefore, can facilitate an entire ecosystem of seamless data transfer. It achieves this with modular units, known as “resources”. Resources range the entire gamut, from patients and practitioners to organizations, medical devices, care plans, appointments and financials; the entire medication pipeline and even clinical reasoning, terminologies and patient consent – literally every aspect of medicine can be represented by a FHIR resource, setting FHIR apart from other, previous attempts at standardization. Quite literally – FHIR covers it all. Once you go FHIR, there’s no going higher!

More on FHIR

FHIR can be used for all types of medical information: from patient and practitioner records, through medication requests and scripts; to medical organizations and HMOs. Any link in the healthcare chain is representable in FHIR.

FHIR is quite strict but also extensible, allowing for all records to comply with the rules set for the record while, at the same time, giving flexibility for all the special data needs of any organization in the process.

FHIR is open source, which means that everything is shareable and there is no need to “reinvent the wheel”. This creates a global community dedicated to the betterment of healthcare systems around the world, to the benefit of humankind.

In the coming years we will see FHIR enter many growing healthcare domains, such as personalized medicine, healthcare apps and connected devices. Alongside disease management, health management in general will see many benefits from FHIR, as it requires interconnectedness between many providers, organizations, devices and more, to the patient’s benefit. Taken together, these developments with FHIR will empower patients by allowing them easier access to their data and an easier experience all around when dealing with health systems, as well as moving us closer to a paper-less health record.

Improving the patient experience and quality of care

Finally, we come to
perhaps the most important conclusion: the more healthcare organizations into
which FHIR is integrated, the more the patient experience and quality of care
will improve beyond recognition.

In the 21st century we
still find ourselves as patients forced to be a walking binder – a
“document courier”. Form 17 (payment autherization), referrals, test
and laboratory results; payment confirmations and more – all these still, in
many cases, are not shared between providers, medical institutes, hospitals and
clinics, and therefore the patient is forced to carry a pile of documents from
place to place. And woe betide you if you arrived for an examination without a
necessary document.

In an ideal world a
patient arrives for an examination and all the necessary documents are already
on the computer, even if the institute does not belong to their health fund.
FHIR will help us end, or at least greatly reduce, the need for the patient to
be the party responsible for collecting and carrying the documents.

And what about the quality
of care? Well, it almost goes without saying that the more information our
treating physicians have accessible about the patient, the better the quality
of care. Doctors will be able to make more informed decisions, prescribe fewer
drugs or unnecessary tests, and advise their patients with greater confidence,
all in a shorter time. Time is a precious commodity and when dealing with
health, sevenfold!
Prevention is always better than treatment, but if
treatment is needed, it will almost always be more effective the sooner it
comes. If there will be less need for expensive tests (for which it is
sometimes necessary to wait many months) we will be able to receive treatment
faster. And if we find ourselves hospitalized – a more efficient sharing of
information between medical bodies may shorten the duration of hospitalization,
which will improve not only the patient’s experience but also lower the
probability of complications arising from hospitalization.

When it comes down to it, when
all the information from the various sources will be in front of the attending
physicians, the chance of a correct and quick diagnosis will increase
significantly, as will the success of the treatment, increasing the chances of

This is a win-win
situation for the patient, the practitioner and the entire healthcare system.

More To Explore


the Synergistic Interoperability Power of ImplementationGuides and CapabilityStatements

Within the healthcare domain, seamless data exchange between disparate systems is paramount for improved patient care and coordinated healthcare delivery. The Fast Healthcare Interoperability Resources (FHIR) standard plays a critical role in facilitating this exchange. Two key resources, ImplementationGuide and CapabilityStatement, act as the cornerstones for ensuring successful interoperability.