Introduction to HL7 FHIR
Health data is one of the most valuable assets for healthcare organizations. The constant exchange of information is critical for the adequate functioning of the medical industry. This is why in the late 80s, healthcare institutions developed Health Level 7 (HL7) standards to facilitate patient data exchange between systems of different medical providers.
Health Level Seven International (HL7) is a non-profit organization that developed the first set of standards in the healthcare industry that were later adopted by the American National Standard Institute.
In simple words, HL7 is a framework that allows various healthcare software solutions (EHR systems, clinical and management software) to integrate and share information.
The HL7 standards provide guidelines and methodologies that enable systems to communicate. They ensure that data-sharing norms and health data definitions related to clinical documentation, medical records, and quality reporting are consistent across systems.
Key concepts of FHIR
FHIR is built on a foundation of modular components called ‘resources.’ Each resource type serves as a basic building block with defined data types and a standard structure. Resources typically include a status element indicating whether the information is current or historical.
When implementing FHIR, developers can extend an existing resource with additional elements rather than creating duplicate resources. For handling non-structured content like images or documents, FHIR provides a binary resource type. Organizations can define a base set of resources essential to their operations while adding extensions for specialized needs.
The FHIR standard uses modern web technologies that developers are already familiar with. It leverages RESTful APIs, which allow different systems to interact and exchange information using standard web protocols. This makes FHIR much easier to implement than previous HL7 standards.
FHIR resources are designed to be reusable and can be combined in different ways to adapt to various healthcare scenarios. Some common FHIR resources include Patient, Observation, Medication, and Encounter. Each resource has a defined structure and follows a consistent format.
The standard supports multiple data formats, including XML, JSON, and RDF. This flexibility allows organizations to choose the format that best suits their needs and existing infrastructure. Most modern implementations prefer JSON for its simplicity and widespread use in web development.
FHIR also includes a strong focus on human readability. Unlike previous standards that produced messages difficult for humans to interpret, FHIR resources are designed to be understood by both machines and people. This makes troubleshooting and development much more straightforward.
The FHIR framework incorporates robust terminology services. It can be mapped to standard medical coding systems like SNOMED CT, LOINC, and ICD-10. This ensures that clinical concepts are consistently represented across different systems and organizations.
Extensions are another key concept in FHIR. They allow organizations to add custom data elements to standard resources without breaking compatibility. This balance between standardization and customization is one of FHIR’s greatest strengths.
What makes FHIR better than other HL7 standards?
FHIR is built on modular, reusable resources that can be combined in different ways to adapt to recent use cases, new technologies, and healthcare scenarios. These features make it easier to implement and customize than previous HL7 standards. Additionally, FHIR is more efficient, using less data and bandwidth than older HL7 standards.
One of FHIR’s key advantages is its set of RESTful web-based APIs that allow different systems to interact with each other and access patient information in real time. This functionality significantly improves care coordination and enables new care models.
FHIR’s approach to version conversion maintains compatibility between implementations. Each new release builds upon the previous version while providing clear migration paths, allowing systems to work seamlessly even when different organizations use different FHIR versions. Organizations can maintain their own copy of critical data while still enabling interoperability through the standard’s many flexible resources.
Security and privacy features are built into FHIR, making it easier for organizations to comply with regulations and guidelines for data sharing. The standard is also designed to be forward-compatible with future developments in healthcare information technology.
Unlike the complex HL7 v3 standard, FHIR offers a more intuitive approach to healthcare data exchange using common internet standards that most developers already understand. This reduces the learning curve and implementation time significantly.
Healthcare organizations benefit from FHIR’s design for incremental adoption, allowing them to implement specific resources that meet their immediate needs. This gradual approach makes FHIR more practical for organizations with limited resources. Robust testing tools and reference implementations help developers validate their FHIR implementations and ensure compatibility across different systems, with each version maintaining backward compatibility.
API use cases in healthcare
APIs can be used in a variety of ways in healthcare to improve the quality of care and reduce
costs. Their implementation across different healthcare domains has transformed data exchange between systems, enabling more efficient workflows and better patient outcomes.
Electronic Health Records (EHR) integration
APIs allow different EHR systems to communicate and share health information, such as demographics, medications, allergies, and lab results. An HL7 integration API serves as the foundation for these exchanges, enabling standardized communication between diverse systems. Third-party integrations, remote access through web apps, patient portals, and automation of manual entry are just some of the benefits APIs bring to EHR systems.
When a patient transfers between healthcare facilities, APIs facilitate the secure transfer of their complete medical history. This eliminates redundant testing and ensures continuity of care. Within hospital systems, APIs connect various departments, such as radiology, laboratory, and pharmacy to the central EHR, creating a unified patient record.
Clinical decision support
APIs retrieve data from different sources, like clinical guidelines, drug databases, and medical literature, to provide medical institutions with cohesive data. This way, healthcare institutions utilize reliable sources to improve the quality of care and facilitate decision-making.
In diagnostic scenarios, clinical decision support APIs analyze patient symptoms against medical databases and suggest potential diagnoses or treatment options. These systems can access vast medical libraries and process information much faster than human practitioners alone.
Population health management
APIs allow healthcare providers to analyze patient data from multiple sources, such as EHRs and claims, to identify high-risk patients. APIs such as Bulk FHIR may be used for collecting essential patient data from different systems for population health purposes.
Healthcare systems can use population health APIs to identify patients overdue for preventive screenings or vaccinations. The same infrastructure can stratify patients by risk level, allowing care managers to prioritize outreach efforts and interventions.
Telemedicine
APIs connect telemedicine platforms with EHR systems, allowing medical professionals to conduct virtual consultations with patients remotely and securely. This enables patient information exchange between healthcare providers and patients in different locations.
Modern telehealth platforms use APIs to integrate with provider scheduling systems, ensuring that virtual visits appear alongside in-person appointments. During telehealth consultations, APIs facilitate real-time data sharing from connected health devices.
Remote patient monitoring (RPM)
APIs support remote monitoring devices to enable the exchange of patient information between devices and systems. For instance, an application that allows patients to track their vital signs can use an API to securely send that information to the medical provider.
For chronic disease management, APIs connect continuous glucose monitors to diabetes management platforms. These systems analyze readings in real time and can alert both patients and providers when values fall outside acceptable ranges, preventing medical emergencies.
Patient engagement
APIs enable the development of patient-facing applications that provide access to personal health information. These apps can send medication reminders, appointment notifications, and educational materials directly to patients.
Patient engagement platforms use FHIR APIs to pull information from EHR systems, allowing patients to view test results, request prescription refills, and message their providers. Financial transparency represents another aspect of patient engagement facilitated by APIs.
Data analytics and research
Healthcare organizations can use APIs to gather and analyze large datasets for research purposes. This helps identify trends, develop new treatments, and improve overall healthcare delivery.
Research networks use standardized APIs to collect de-identified patient data across multiple institutions. This enables large-scale observational studies with diverse populations. Predictive analytics systems use APIs to pull data from various clinical sources, applying algorithms to forecast patient deterioration or readmission risk.
The 21st Century Cures Act (2016) and the Cures Act Final Rule (2020) are the critical factors that motivated healthcare institutions to invest in seamless information sharing. The latter requires IT providers to develop standardized APIs that enable data exchange between software systems based on the FHIR standard.
Common use cases for HL7 FHIR API
FHIR implementations leverage the generic API capabilities described above but add specific advantages through their standardized resources and protocols.
Here are key ways FHIR APIs are being deployed:
- Patient portals represent one of the most common implementations, allowing individuals to access their medical records securely. These portals give patients the ability to view lab results, medication lists, and upcoming appointments without calling their provider.
- Mobile health applications leverage FHIR APIs to connect with healthcare systems. These apps can track vital signs, medication adherence, and other health metrics, then securely transmit this data to healthcare providers. This creates a continuous flow of information between patients and their care teams.
- Clinical decision support systems use FHIR to access patient data and provide evidence-based recommendations. When a physician enters a diagnosis, these systems can suggest appropriate treatments based on the latest clinical guidelines and the patient’s specific health profile.
- Health information exchanges (HIEs) implement FHIR to facilitate data sharing between different healthcare organizations. FHIR servers host these capabilities, acting as centralized repositories that manage and provide access to patient data. When a patient visits a new provider, FHIR APIs enable quick access to their medical history from previous providers, ensuring continuity of care.
- Research networks use FHIR for standardized data collection across multiple institutions. This standardization allows researchers to compare results more effectively and accelerate medical discoveries. FHIR’s structured data format makes it ideal for large-scale data analysis.
- Precision medicine initiatives depend on FHIR to integrate genomic data with clinical records. This integration helps clinicians develop personalized treatment plans based on a patient’s genetic profile, medical history, and current health status.
- Emergency services benefit from FHIR by gaining rapid access to critical patient information. When emergency responders arrive on the scene, they can use FHIR-enabled systems to retrieve allergies, medications, and medical conditions, potentially saving lives in time-sensitive situations.
- Quality reporting systems utilize FHIR to automatically extract performance metrics from clinical systems. This automation reduces the administrative burden on healthcare providers while ensuring accurate reporting to regulatory agencies and payers.
FHIR implementations rely on standardized search parameters to locate and retrieve the following resources: patient demographics, clinical observations, and care plans. These parameters allow systems to exchange data efficiently in the proper context. Healthcare platforms use these capabilities to share data between providers, ensuring that the resource content remains consistent across organizational boundaries.
Challenges and how to overcome them
Healthcare organizations face numerous obstacles when implementing FHIR and API solutions. The lack of standardized API functionality causes delays in software development. This creates inconsistencies in how different vendors implement the same specifications.
Here are some of the challenges:
- Poor communication between IT teams and medical workers often hampers successful implementation. When technical and clinical staff don’t collaborate effectively, the resulting solutions may miss critical workflow requirements.
- Insufficient documentation and support affect implementation quality. Without clear guidelines, developers may interpret standards differently, leading to compatibility issues between systems.
- Resource constraints present significant barriers for many organizations. Implementing and maintaining APIs in a healthcare environment requires specialized skills that may be unavailable or unaffordable, especially for smaller healthcare providers.
- Data quality and mapping create additional challenges. Inconsistent or inaccurate data mapping can lead to errors in patient care. Healthcare providers must verify that their systems accurately translate information between different formats.
- Legacy systems integration remains problematic. Older systems often use proprietary data formats that are difficult to map to FHIR resources. These integration challenges frequently require costly custom solutions.
Last but not least, governance models for APIs are often underdeveloped in healthcare organizations. Without clear policies on data access and maintenance responsibilities, interoperability initiatives can become disorganized and ineffective.
Best practices for API integration
Successful FHIR API integration requires a strategic approach that begins with designing a clear API strategy with defined endpoints and data models.
When implementing, consider using a Java API framework, which offers robust libraries for healthcare integration. Document your APIs thoroughly using tools like Swagger or OpenAPI to make them accessible to developers.
It’s important to implement robust API security from the beginning. Use OAuth 2.0 for authentication, consider rate limiting to prevent overload, and implement proper access controls. Healthcare APIs require particular attention to data privacy and regulatory compliance due to the sensitive nature of the information they handle.
Next, create a developer-friendly experience with consistent API patterns. Maintain version compatibility to avoid breaking dependent applications when updates occur. Provide sandbox environments where developers can test integrations before accessing production data, allowing them to identify and resolve issues early.
Keep in mind that monitoring API performance and usage patterns is essential for ongoing optimization. Implement logging and analytics to track how your APIs are being used and by whom. This information helps identify bottlenecks and opportunities for improvement as your implementation matures.
Organizations should also consider adopting an API management platform to streamline governance. These tools help with developer onboarding, key management, usage tracking, and policy enforcement across all your healthcare APIs, creating a more consistent experience for all stakeholders.
Do not forget to test API endpoints rigorously for both functionality and edge cases. Ensure your APIs handle errors gracefully with meaningful status codes and error messages that help developers troubleshoot problems quickly and effectively.
Also, develop clear guidelines for third-party developers accessing your APIs. Provide sample code, tutorials, and reference implementations to accelerate adoption. Consider hosting hackathons or developer forums to build a community around your healthcare APIs and gather valuable feedback.
Finally, plan for API lifecycle management from the start. As healthcare standards evolve, your APIs will need to adapt while maintaining backward compatibility. A well-defined deprecation policy helps partners transition smoothly to new versions without disrupting critical healthcare operations.
Transform the healthcare delivery of your services with new technology Take the first step towards a more interconnected healthcare environment by learning more about HL7 and APIs together with BGO Software’s team of experts.
Conclusion
The transition from basic HL7 standards to modern HL7 FHIR APIs marks a significant advancement in exchanging healthcare data.
The FHIR specification enables seamless communication between existing systems and allows healthcare organizations to integrate data more efficiently while maintaining strict security and privacy controls. A well-planned FHIR implementation enhances interoperability, streamlines workflows, and improves patient engagement.
For example, a hospital that integrates a FHIR API with an electronic health record (EHR) system can provide real-time access to patient data across different providers. This reduces redundancy and improves care coordination.
While challenges remain—such as aligning with evolving standards and ensuring compliance—the long-term benefits of standardized APIs support the industry’s shift toward more connected, patient-centered healthcare.
