Digital Quality Summit: FHIR for Dummies (or the Forgetful)

Fast Healthcare Interoperable Resources (FHIR) comes up a lot in discussions of digital quality measurement. But how many people who work in quality can say more than a few sentences about what FHIR is, how it works and why it matters?

About 100 people new to the field or eager to refresh their understanding of FHIR received an accessible primer on the July 12 Digital Quality Summit (DQS) Preconference topic.

DQS track lead Dr. Viet Nguyen of Stratametrics led the discussion.

Takeaways and “ah-ha’s” to help non-technical quality advocates are below.

Questions about FHIR Reflect Its Spread

Dr. Nguyen framed FHIRs growth by explaining how questions he gets about FHIR have evolved.

About eight years ago, “What is FHIR?” was top on people’s minds. As FHIR became better known, the common query became, “Why is FHIR important?” Once a critical mass of people understood FHIR’s advantages, “How can I use FHIR?” became the frequent focus. Now that FHIR is well known, “When will FHIR be updated?” tops the FAQ list.

Nguyen added, “FHIR is now at scale. The major EHRs have FHIR endpoints available for their customers and are working on transitioning from version 3.0 of FHIR that they initially implemented, to version 4.0.”

Industry and Government are FHIR Fans

People who don’t work with Electronic Health Records might not realize how pervasive FHIR has become.

The five leading EHR developers that serve 9 out of 10 hospitals support FHIR. Approximately 96% of hospitals have EHRs that are FHIR-enabled. And almost 8 out 10 clinicians have FHIR-based APIs.

Government enthusiasm for FHIR is a reason for FHIR’s wide adoption.

Two recent examples of CMS or ONC making moves that help FHIR came up during the preconference.

One is the final technical standards in the ONC 21st Century Cures Act Final Rules. Those rules name FHIR version 4.0.1 as a specification required for EHR or health IT certification.

The other example was just 3 days old: The July 9 release of United States Core Data for Interoperability, version 2 (USCDI v2). Those regulations say how to standardize and exchange data about social determinants of health, among other kinds of data.

The Big Buttons Define Key Terms

Non-technical novices who plunge into discussions of FHIR may get the impression that FHIR if full of fuzzy, ambiguous terms.

To the uninitiated, FHIR concepts can sound synonymous. For example, couldn’t a “profile” be a kind of “resource”?

It is a relief to learn that FHIR definitions and terminology are prescribed and precise.

The FHIR homepage defines key terms side-by-side. The concepts build on each other in a step-wise fashion: They are the buttons users click to navigate the FHIR site.

fhir homepage banner

  • A Resource is a fact—often about a patient or medical condition—expressed as computer code and given its own URL. Age, gender or diagnosis are examples of Resources. Each Resource contains structured data about the underlying topic or fact.

Resources are standardized in ways that make them reusable. That’s why “core” FHIR or “base” FHIR resources cover about 80% of health care workflows—or four-fifths of everything that happens in health care worldwide.

  • A Profile is a constraint on a Resource. These constraints help users adjust or customize Resources.
  • An Extension is the FHIR term for assigning data requirements to a Resource. That matters to organizations eager to assess and improve health equity. (See “FHIR Helps with Equity” below.)
  • An Operation is an action or interaction that users apply to Resources. Searching, reading or updating records are examples of Operations.

Seeing these short, intuitive definitions laid out left-to-right on screen demystifies FHIR and assures newcomers that FHIR fits together.

FHIR’s homepage navigation and practical definitions are the basis of a larger point: FHIR prizes and requires consistency and careful matching at different levels of analysis and function.

Non-technical novices leave with the impression that FHIR is precise and layered, top to bottom. Seeing this commitment to consistency increases the intuitive understanding that FHIR aids interoperability by itself being precise and by avoiding ambiguity.

FHIR Helps with Equity

The FHIR concept of Extensions is one way FHIR forms a bridge between digital measurement and another quality priority: health equity.sign reads health equity

Noting that FHIR is an international standard, Dr. Nguyen explained: “In the US, we’re required to document race and ethnicity. So we created the US core FHIR profile, which has an extension for race. We do this at a national level; vendors may want to do that at an individual organization level. And the nice thing is, once an extension is created, you can reuse it in a different profile.”

Nguyen elaborated, “Instead of just saying that you have to represent race and ethnicity, we use a certain code for race and ethnicity. And we can double-check each other to make sure that we are being consistent. That is powerful because it allows us to have interoperability, not only on a data model, not only on the data exchange, but down to the data elements.”

Overall, the pre-conference discussion of FHIR was excellent preparation for the deep-dive that DQS gave conferencegoers over the next three days.

For more information about FHIR, NCQA recommends HL7’s FHIR Fundamentals course.

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