HL7 have produce a Wiki on FHIR which provides a very helpful overview of the values associated with FHIR (FHIR, Principles, 2017). From this Wiki (at the time of writing) these include but are not limited to
- Applications should be useful for 80% of scenarios and extensions can be used for the remaining 20% of scenarios
- FHIR emphasises flexibility over tight specifications
- FHIR utilises open source development principles
- FHIR should be free to use
- FHIR is backward and forward compatible
- Use of web tools
- FHIR is designed for use across a large variety of environments
Fast Healthcare Interoperability Resources (FHIR) describes a set of standards that facilitate the transfer of healthcare information between electronic healthcare systems. The video above is from the QVera clips YouTube channel. FHIR has been developed by HL7.
Overview for Clinicians
There is a useful overview of FIHR for clinicians which provides a non-technical overview (FHIR Overview Clinicians, 2017). This overview explains the terminology of FIHR. The FIHR ‘mindset’ involves thinking about electronic patient records in a very different way from paper based records. The section on REST simplifies the basic processes that are involved in managing records in an electronic patient record (EPR) system and more specifically with the FIHR specifications. The RESTful API utilises a specific set of transactions for accessing data such as reading and updating a record.
What is an API?
API stands for Application Programming Interface. An API can be thought of as the providing the building blocks for creating a software program. These include protocols and code and make it easier for the programmer to develop a program.
HL7 is described in the NHS interoperability handbook as applying to the Interoperability Framework. HL7 is an organisation that develops a framework and standards for interoperability of health information systems. Their website can be found here and the organisation also has a well established social media presence.
Patient records are central to the delivery of healthcare and serve a number of functions including the recording of clinical assessments and interventions. Aggregated data is also utilised at a local and national level to inform commissioning.
Electronic Patient Records
The digitisation of patient records offers a number of advantages over paper based records. These advantages include automated backup of records, reduced use of physical storage space (since paper based notes are switched to servers), off-site access to records using mobile devices and the potential to develop analytical clinical support tools which use computers to process clinical data to help improve clinical decisions. Not all healthcare services have electronic patient records but most providers are moving in this direction.
Getting Electronic Patient Records to Talk to Each Other
When patients move between healthcare providers – for instance between primary care and the hospital – they may find that one provider does not have information that the other provider has. There are many providers and many electronic paper record systems. For two systems to talk to each other they have to solve a number of problems. When these problems are solved a patient can move between providers and healthcare information can be accessed by the different providers. A key solution to this problem of health information gaps is the Health Information Exchange (HIE).
The Health Information Exchange
There are many definitions of what a Health Information Exchange is. (Hersh et al, 2015) define a HIE as follows:
‘Health information exchange (HIE), the electronic sharing of clinical information across the boundaries of health care organizations’
Whilst this definition is simple, the process of sharing clinical information between healthcare organisations is technically complex and encompasses a range of software, hardware and governance issues. The process of helping systems to talk to each other is helped by the development of standards. A set of standards is outlined in the NHS interoperability framework.
The Interoperability Framework
A digital copy of the Interoperability Handbook can be found at the NHS England website (NHS England, 2017). The handbook explains how an interoperability framework can support an interoperability strategy. The Interoperability Framework has three layers – a governance layer, an exchange layer and an interpretation layer.
The Standards Applicable to the Interoperability Framework
Appendix A in the Interoperability Handbook shows how various standards map onto the Interoperability Framework (NHS England, 2017).
(FHIR Principles, 2017). http://wiki.hl7.org/index.php?title=Fundamental_Principles_of_FHIR, accessed 17th April 2017.
(FHIR Overview Clinicians, 2017). https://www.hl7.org/fhir/overview-clinical.html, accessed 16th April 2017.
There is also an NHS Digital Twitter account here.
Links to Other Posts in the Health Information Exchange Series
Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link.
TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link.
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