The global digital health market size is projected to grow from $332.53 billion in 2022 to over $900 billion in 2032. Digital health technologies make a significant impact on the level of patient engagement and satisfaction with the healthcare services they receive. Recently, we discussed the evolution of healthcare data standards in the U.S. and described the initiatives that provide patients with advanced control over their healthcare data. But today, we will discuss how to implement FHIR and how to create an FHIR implementation guide.
Patients now make good use of the freedom granted to them by government bodies to achieve more patient-centered care. For example, citizens of the United States can choose any app they like to connect to an EHR and display personal health data. We discussed a patient’s authorization use case in our article about SMART on FHIR. SMART on FHIR reduces costs and time for new app implementation. FHIR implementations allow for the development of patient-facing health applications with FHIR that can integrate with different healthcare systems and provide patients with personalized health information and insights.
Also, in our article about regulatory compliance in healthcare, we talked about the Dutch experience and how the MedMij standard promotes the digital exchange of health data between patients and healthcare professionals. Public institutions worldwide realize the importance of EHR interoperability and dedicate their efforts towards achieving it.
The HL7 FHIR standard has become a leading solution in different countries for facilitating interoperability in healthcare. The standard became more popular thanks to the standardized approach to healthcare data exchange. Also, to ensure that FHIR is not a burden for healthcare stakeholders, the HL7 international organization offers a tool for the successful implementation of the standard, known as the FHIR Implementation Guide.
Read Also: FHIR vs. HL7: What to Choose
FHIR IMPLEMENTATION GUIDE (IG) AND ITS CONTENTS
What is an FHIR Implementation Guide?
A FHIR Implementation Guide is a set of instructions for implementing the FHIR standard in a specific healthcare context. IG is a roadmap for healthcare stakeholders that want to adopt the FHIR standard and leverage its advanced data exchange capabilities. FHIR IG is a type of FHIR profile.
Why do we need profiles?
FHIR is an international specification that covers many different contexts in healthcare (e.g., patient management, medical billing, scheduling, etc.). It is one of the most flexible healthcare data standards since FHIR Resources standardizes about 80% of use cases in healthcare. Profiling allows for coverage of the 20% of use cases that fall outside the core FHIR specifications.
A profile is a StructureDefinition FHIR resource tailored to a specific use case. It is one of the main FHIR artifacts. A profile defines rules, extensions, and constraints for a resource. Therefore, profiling is the essential step in the FHIR standard implementation.
Read Also: How Australian Digital Health Is Embracing FHIR Standards
FHIR ARTIFACTS
FHIR profile: contents of an FHIR profile vary due to differences in requirements and regulations of different healthcare ecosystems. However, all profiles include components that define constraints and extensions, the structure of a resource, and rules for its usage.
FHIR terminology: one of the key FHIR components that ensures the consistency and accuracy of exchanged data. FHIR terminology consists of:
| CodeSystem | a set of codes that represent the medical concepts in FHIR resources |
| Value Sets | a set of codes from one or more CodeSystems intended for a particular context |
Hl7 FHIR tutorial Implementation Guides may include terminologies required to make the IG work.
Terminology allows for the correct interpretation of healthcare data regardless of the systems participating in the healthcare data exchange. FHIR terminology impacts clinical decision-making by defining codes representing clinical concepts in FHIR resources that allow for meaningful use of healthcare information.
Search Parameters: in the context of FHIR, search parameters are used for retrieving FHIR resources that satisfy a set of conditions. Search parameters define the criteria for searching specific healthcare information within FHIR resources. Earlier, we answered common questions about FHIR Search, so you should check this article out to learn more about FHIR search parameters.
The IG may determine search parameters to make an FHIR Implementation Guide work with a specific FHIR or custom profile.
FHIR Operations:
FHIR Operations refer to operations that can be performed on FHIR resources. The operations in FHIR are based on RESTful principles and use HTTP protocol. FHIR operations include the following components:
1. The base URL (the URL of an FHIR server used for accessing a resource);
2. Resource Type (e.g., “Patient”, “Encounter”);
3. Operation Type (e.g., create, read, update, delete);
4. Parameters (allows for additional search parameters that do not affect the server’s state).
FHIR Implementation Guides may include a requirement for the utilization of standard FHIR operations designed for specific use cases. A Guide can define operations to cover the use case that underlies that particular implementation guide.
HOW TO FIND A FHIR IMPLEMENTATION GUIDE
Finding a specific FHIR implementation guide covering a particular use case is often more complicated than creating a new one. Unfortunately, despite the vast volume of IGs, the FHIR specification does not provide instructions and requirements on where to store/find FHIR IGs. However, there are several sources for FHIR Implementation Guides to check before committing to your own FHIR Implementation Guide development.
FHIR Implementation Guide Registry
As the name implies, the site features a collection of FHIR Implementation Guides that developers of new health IT solutions and other stakeholders can use to find an IG to set their project on FHIR.
The FHIR IG Registry includes only the Creating & Publishing FHIR Packages the FHIR community balloted for. That is a main peculiarity of the FHIR standard since it was the first standard for the healthcare industry designed by developers, not clinicians. The website includes the existing IGs available for browsing by filters (e.g., by country, release, product, contents, category, etc.).
The FHIR IG registry is the first website to check when considering leveraging the FHIR standard and see the IGs from the National Base category to discover FHIR implementation journeys for countries such as the U.S. Also, on the website, you will find recommendations on which tools to use for creating your own HL7 FHIR Implementation Guide.
Need an FHIR IG example?
The US Core FHIR Implementation Guide provides a set of requirements for adopting the profiles included in the US Core. The Office of the National Coordinator for Health Information Technology (ONC) sponsored the development of the US Core Requirements.
The US Core benefited mainly from the testing and guidance of The Argonaut Project‘s team (one of the primary FHIR accelerators in the U.S.). The US Core Implementation Guide includes the following:
- Introduction and background information;
- The conformance rules and general requirements for all actors;
- The mandatory elements to support;
- Guidance for the use of profiles and transcriptions for profiles from the guide;
- Data classes and data elements for US Core profiles;
- Guidance on medication access for patients and providers;
- FHIR Artifacts: detailed description for all FHIR objects for this guide;
- A set of profiles and extensions defined in the guide for data exchange;
- Search parameters and operations used for US core transactions;
- Terminology: value sets and code systems for US Core profiles;
- The expected FHIR capabilities for actors;
- General security requirements and recommendations (the complete list is available at http://hl7.org/fhir/us/core/).
The Implementation Guide provides constraints on FHIR resources and the set of FHIR RESTful interactions required to create US Core Profiles and access patient data. The main goal of the US Core IG is to promote interoperability and the adoption of the FHIR standard to improve healthcare data exchange in the country.
Read Also: Mapping Healthcare Data to HL7 FHIR Resources
HOW TO CREATE A FHIR IMPLEMENTATION GUIDE
Creation Tools
Here are some FHIR implementation Guide creation tools in the market:
The FHIR Implementation Guide (IG) Publisher
The first tool mentioned on the IG Registry website is the IG Publisher. It is a creation and publishing FHIR Packages platform, which allows for converting materials into XML, JSON, and TTL formats. Building the IG with the IG publisher involves four steps:
- The IG publisher installation;
- Defining the resources that will form the foundation of the Implementation Guide;
- Developing the structure and content of the Implementation Guide;
- Running the IG publishing process.
The IG Publisher is a powerful tool that supports various programming languages, bundles, and spreadsheets. Thus, the diverse options guarantee the accessibility of the IG Publisher’s functionality to all stakeholders requiring a comprehensive FHIR Implementation Guide creation tool.
Simplifier.net
Simplifier is an online platform that works with the Forge (FHIR profiling tool), which allows for creating and sharing a FHIR Implementation Guide. The platform provides tools for maintaining FHIR artifacts. Also, it serves as a repository where developers can create, upload, download, and find FHIR Implementation Guides.
This platform encourages the reuse of existing profiles and extensions by providing a centralized repository and support for various searching options (e.g., IGs developed for international or regional projects). In addition, the site offers free and paid plan options for developers.
In one of our previous articles, we discussed the FHIR profiling tools. The list of the best FHIR profiling tools includes:
- The Kodjin Profiler Tool
- The Forge from Fire.ly
- Trifolia-on-FHIR
Why do we need profiling tools?
The process of an FHIR Implementation Guide involves identifying the specific resources, profiles, extensions, and terminologies that provide the basis for it. The FHIR profiler allows for automatizing the profiling process so that a developer can customize an FHIR resource faster and easier.
Apart from that, a profiling tool improves the accuracy of a profile since it ensures that it complies with the FHIR standard. A profiling tool helps to create consistent profiles and extensions in no time. Check out our article about FHIR profiling tools to discover how to choose and use them.
HOW TO IMPLEMENT FHIR
However, FHIR implementation can be quite complex since it requires deep knowledge of the ever-changing domain requirements. Kodjin’s certified FHIR and profiling experts are ready to help you with an FHIR Implementation Guide development.
The Kodjin Interoperability Suite includes advanced FHIR-based tools with proven performance under national-level projects. Our team will help you define the scopes for an FHIR Implementation Guide, complete the profiling, and ensure the IG’s conformance to the FHIR standard.
We use our extensive experience to help clients leverage FHIR standards for better healthcare and streamline operations. Contact us to learn more details about our enterprise-level solutions.
Real-world Examples of FHIR Implementation
FHIR for a National eHealth System
The Ukrainian healthcare system needed a significant change because healthcare professionals still used paper documents. The Edenlab team built a new and modern health system for the whole country using the FHIR standard. It resulted in a healthcare system with over 36,5M patient records that can be easily shared with doctors and patients. This project is one of the biggest FHIR projects in the world.
HEALTH.ASIA: FHIR for Accurate Auto-adjudication of Medical Claims
For Heals.Asia, a major company in Hong Kong that processes insurance claims, Edenlab’s team created an auto-adjudication engine using FHIR. This engine is like a rule engine and can handle complex limits and rules for insurance plans, such as deductibles, co-pays, co-insurance, out-of-pocket maximums, family limits, and min/max patient age. The team conducted mapping to the currently existing documents and created FHIR profiles. As a result, the client received a fully functional FHIR-based auto-adjudication engine that efficiently handles these different rules and constraints.
Conclusion
Healthcare data interoperability has become a task of national scale and importance in many countries, so FHIR is on everyone’s minds today. FHIR can significantly simplify health cloud implementation by providing a robust base for interoperable exchange, resulting in improved consistency and quality of exchanged data.
FAQ
Are there any specific tools or resources that can aid in FHIR adoption?
The Kodjin Interoperability suite includes all the needed tools for effective adoption of the FHIR standards, such as:
- Kodjin FHIR Server: the powerful tool for managing, validating, and storing healthcare data.
- Kodjin Terminology Service: allows for working with standard and proprietary terminology systems.
- Kodjin FHIR Profiler: automates and speeds up the creation of dynamic FHIR profiles.
- Kodjin FHIR Mapper: allows for mapping healthcare data to HL7 FHIR resources for improved interoperability.
How can healthcare providers ensure compliance with FHIR standards and regulations?
The strategy for achieving regulatory compliance in healthcare depends on the location of a stakeholder. The European regulations are different from the US ones and we highly recommend you reading our article about regulatory compliance in healthcare where we discussed this topic in detail.
Can FHIR be integrated with existing healthcare systems, such as EHRs and HIS?
Integration of the FHIR with existing healthcare systems is possible with proper tools, the knowledge of the healthcare domain, and an exceptional expertise in FHIR.
