FHIR for Consumers

This page is intended to serve as an introduction to FHIR for consumers of the healthcare system.

Overview of FHIR

FHIR stands for Fast Healthcare Interoperability Resources. (It's hard to get a globally unique acronym.)

FHIR defines a set of rules that describe how computers use the web to share and understand healthcare information. By having a common set of rules, computer programmers can write programs that will reliably share healthcare information without first having to talk to the programmers of every other system they might want to share healthcare information with. That saves a lot of time (and money) and lets more programmers write such software or make their existing software better.

FHIR is about "Healthcare" - that's a wide net. It covers:

• Descriptive information about the people, places and things involved in healthcare (patients, doctors, clinics, devices, drugs, etc.)
• Clinical summary information - allergies, problems, medications, lab results, imaging data, vital signs
• Appointments, Referrals and other processes that help ensure the right care gets delivered at the right time
• Care protocols, decision support, and clinical quality & consistency measures - to help improve care quality and consistency
• Financial processes such as billing and insurance
• Clinical research
• and a whole lot of other things

The key is that FHIR is a standard that defines the kinds of information a patient would like to have about themselves - their record of medical care, as well as the wider processes that are necessary to provide that care.

FHIR defines a structured format that potentially allows patients to load the data into their own structured records. More importantly, that information is defined in such a way that it's easy to find, sort, manage and filter much more efficiently than having a great big list of documents that have to be read each time.

Freedom

Unlike many other healthcare standards, FHIR is free. No payment or license agreement is required to use it (whether commercially or otherwise), and it's posted free to the web for anyone to see. FHIR is developed using standard open community processes and the FHIR community works hard to make high quality information and support freely available.

The aim of FHIR is to reduce the cost and effort of exchanging healthcare information, so that data sharing becomes simple, and healthcare providers can and will set up processes that enable sharing of higher quality health information in a more consistent manner - which lead to better health outcomes.

Variability

The healthcare system is extremely fragmented - different countries and cultures have very different views of what 'health' is, and how care should be provided, funded and used. Different clinical disciplines have very different approaches to how to represent, collect, store, share and use information in support of their care processes. There's no single authority that can make rules about what clinicians do, and clinicians are taught to be highly self-accountable. HL7 (the organization that publishes FHIR) has no authority to tell healthcare providers how they should provide care.

The consequence of this is that the FHIR specification is extremely flexible and there's a set of features in FHIR that make it possible to manage this variability. But that comes with a price: programmers that work with FHIR have to deal with this variability - and that's harder (and costlier) than it could be with a more proscriptive standard.

Data Availability and Security

FHIR defines how things can be done. But because it's an international standard, and used in all sorts of contexts, it can't make any hard and fast rules about what information has to be shared, when it has to be shared and what the security around that needs to be. Instead, making those rules about how FHIR should be used in a particular context (called 'implementation guides') is left to a patchwork of regulators, standards bodies and vendor consortiums around the world.

Consumer Outcomes

In spite of the problems around lack of standardization of the healthcare process, FHIR is a key to building a patient-focused healthcare system. The ability to reliably share information with patients at an affordable price creates an environment where the patient and their own record can be the pivot around which their care is coordinated. The ability to become more deeply integrated in the care process - through better information exchange - allows the healthcare system to be more patient focused and responsive rather than provider focused.

Note that the healthcare system needs more than just better information flow to make these kids of changes. However, better (and cheaper) information flow is a critical pre-condition, and that's the focus of the FHIR community.

Progress to Date

To date, the FHIR community has focused on the basic building blocks, working towards being the standard that best enables healthcare data exchange globally. As of 2017, we're about half way through creating that foundation - the standard itself, and we're starting to focus on supporting use of the standard to provide real world solutions.

todo: follow up, more specifics about plans.