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 to use the web infrastructure to exchange information about healthcare, and understand what each other is saying. In essence, it's a set of pre-agreements about what computer programmers are able to assume about each other's behaviors in advance, so that they can reliably integrate information from other applications into their applications workflow.

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

• basic identification information about patients, doctors, etc,
• basic clinical summary information - allergies, problems, medications, diagnostic reports & data, vital signs
• support for referral and clinical and procedural workflow in clinical contexts
• sharing knowledge - clinical quality & consistency measures, decision support, and coding support
• billing and claiming workflows
• sharing data for clinical research

And a whole of other things. The key is that FHIR is a format that supports the kind of information a patient would like to have about themselves - their record of medical care, as well as the wider process that is necessary to provide that care.

FHIR defines a structured format that means that patients can load the data into their own structured records that sort and manage the information, rather than just having a great big list of documents that have to be read each time.

Freedom

Unlike many other healthcare standards, FHIR is a free public good. 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 whole purpose of FHIR is to reduce the cost of exchanging healthcare information, so that instead of being prohibitively expensive to set up reliable and safe data exchanges, data integration becomes a commodity, and healthcare providers can and will set up processes that leverage data integration.

Variability

The healthcare system is extremely fragmented - different countries and cultures have radically different views of what 'health' is, and how care for it should be provided, funded, and used. Different clinical disciplines have very different approaches to how to 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 provider healthcare

The consequence of this is that the FHIR specification is extremely flexible, and there's a whole set of features in the specification that make it possible to manage this variability. But that comes with a price: programmers that work with FHIR have to deal with all this openness, and that's harder (and costlier) than it could be if there wasn't such variability.

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 shared, when it has to be shared, and what the security around that needs to be. Instead, make those rules (called 'implementation guides') is left to a patch work of regulators, standards bodies, and vendor consortiums around the world.

Consumer Outcomes

In spite of the problems around lack of standardization of the the healthcare process, FHIR is a key to building a patient-focused healthcare system. The ability to reliably share information with the patient at and 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 more deeply integrate the care process - through better information exchange - allows the healthcare system to be more patient focused rather than provider focused.

Note that the healthcare system needs more than just better information flow to make these kids of changes - but 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, building towards being the standard that best enables healthcare data exchange. As of 2017, we're about half way through the basic block - the standard itself, and we're starting to focus on supporting building solutions that use the standard to provide real world solutions.