Q&A: A beginner’s guide to FHIR

  • George E. Cole, Jr.
  • 01/06/2016

Interest in FHIR (Fast Healthcare Interoperability Resources) is growing as the standard for exchanging healthcare information takes shape. What is it and what will it mean for healthcare providers? Here are some frequently asked questions and answers:

Q. What is FHIR?

A. FHIR (pronounced “fire”) is a newly emerging international specification that standardizes the exchange of electronic healthcare information. First sponsored by Health Level Seven International (HL7) in 2011, FHIR incorporates the best features from previously developed standards.

Q. How is FHIR different from other interoperability standards?

A. The major difference between FHIR and other standards is simplicity and flexibility. Fast – the F in FHIR – expresses the intent to make this standard faster to learn, develop and implement.

Essentially, each application of the FHIR standard requires  a resource approach to the information model (e.g., Medication, Procedure, or Immunization), which is more granular than other standards. Systems can use those FHIR Resources to then create commonly used content groupings that we see today, such as lists and documents. It is flexible and can enable faster and easier implementations.

FHIR supports four information exchange paradigms, most notably REST, the software architectural style that forms the basis for the World Wide Web. This approach aligns FHIR development more closely to other Internet development efforts outside of health care.

FHIR’s flexibility also means it will work across the entire spectrum of health care – from an orthopedic surgeon in Urbandale, Iowa, U.S.A. to a pediatrician in the heart of London.

Q. What is the current status of FHIR?

A. FHIR is currently a Draft Standard for Trial Use (DSTU2). The Office of the National Coordinator (ONC) 2016 Interoperability Standards Advisory lists FHIR as a Draft Standard, with Piloted Implementation Maturity, Low Adoption (less than 20%), Free Standard, with no currently available test tool to evaluate conformance.

Essentially, we expect to see Implementation Maturity, Adoption, and Test Tool development accelerate rapidly in 2016. FHIR is expected to be final in 2017.

Q. What is the Argonaut Project’s role with FHIR?

A. The Argonaut Project is a group of volunteer healthcare providers, health IT companies and universities working together to test the interoperability of FHIR implementations and profiles. Think of it this way: FHIR defines what can be sent, and Argonaut defines what must be sent. One of the strengths of FHIR is that the healthcare community is defining how to use it and what works best for the community’s needs.

Argonaut phase one focused on both data and document queries in support of U.S. Realm requirements, mostly as expressed by the Common Clinical Data Set. Phase two has continued with a focus on security for cross-enterprise authentication.

Q. What is Allscripts doing with FHIR?

A. Allscripts supports the ongoing work with the development of this new standard and participates in the Argonaut Project testing workgroup, HL7 Working Groups and Connectathons. We’ve completed initial development of a web service that will enable user applications to request and receive clinical data using FHIR. We’ll also attend the HL7 working group meeting, January 10-15, 2016.

Because we’ve written our own Open application programming interfaces (APIs), we have extensive experience addressing interoperability challenges across multiple systems. Having this set of robust, commercially proven APIs will make it easier for us to help our clients succeed with FHIR and interoperability more broadly.

Q. What should healthcare providers be doing to prepare for FHIR?

A. Preparing for FHIR is more of a technical issue for health IT companies to incorporate and test, so there are no immediate action steps providers need to be doing. Of course, healthcare providers should already be working towards meeting requirements aimed at improving interoperability, such as Meaningful Use Stage 3 and the 2015 Certification API requirements, which will likely be tied to FHIR in future versions.

FHIR is an exciting standard that we believe will become widely adopted. It is a logical next step along the path Allscripts started in 2007 with our own Open API, and we look forward to taking working with others in the industry to keep the progress happening.

You can find more Frequently Asked FHIR Questions here.

George Cole update on Jan. 25, 2016:

This blog post has “kindled” a lot of reader interest.  (Sorry, but in the technical geeky world, bad FHIR puns are encouraged.) Our team is working on a follow-up article, with more answers to frequently asked questions about what Allscripts is working on, how it relates to some of the 2015 Certification requirements and more. Be sure to comment here with your questions so we are certain that we cover the breadth of reader interest in FHIR.


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About the author

George Cole is Principal Scientist, Community Solutions at Allscripts. He has been with Allscripts for more than 30 years and leads internal efforts on standards and interoperability. Outside of Allscripts, he is currently the lead of the Content Standards Workgroup for The CommonWell Health Alliance. He is an active member of HL7’s Structured Document and also Health Standards Integration workgroups. George had the honor and privilege to serve as a member of the HIT Standards Committee’s Architecture, Services and APIs Workgroup. Last year he was an invited panelist at the IOM Digital Learning Collaborative Roundtable on Value and Science-Driven Health Care. He was an active participant with the Beacon-EHR Affinity workgroup, and a member of the CCHIT Interoperability Experts Panel. He represented the EHR Association as a member of the CDC IISB Transport Experts Panel. George was a Faculty Board member of The CDA Academy. George is am a member of the IHE Patient Care Coordination Technical Committee, and the ITI Technical Committee. He has been co-editor of the following IHE profiles: Retrieve Form for Data Capture (RFD); Referral / Order Linking (ROL); Multiple Content Views (MCV); Reconciliation of Clinical Content and Care Providers (RECON). He was also profile mentor for the Structured Data Capture (SDC) profile in the QRPH domain

9 COMMENTS on Q&A: A beginner’s guide to FHIR


Ram says:

01/08/2016 at 12:57 pm

Awesome summary of FHIR, George.


Kim Weesner says:

01/13/2016 at 5:29 pm

Very good summary of FHIR, I have been coding for FHIR over a year now waiting for someone to finally use it. Will check out your site today, would solve many problems for me.
Kim Weesner
HIT for Frank G Rubino MD

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    Kimberly Jones says:

    02/01/2016 at 2:25 pm

    Great summary. Thank your for sharing.

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    dovi says:

    09/18/2016 at 8:08 am

    thanks a lot!

    so what is the difference between Unity API and FHIR? can you do everything with both?

      Tina Joros says:

      09/21/2016 at 8:47 am

      The Unity API is a proprietary API that Allscripts started building in 2007 and supports bi-directional data exchange and other actions with Allscripts solutions. The FHIR APIs are developed and supported by the HL7 International group for use by any EHR; Allscripts ensures that we support functionality that allows developers to use these APIs to connect with Allscripts solutions. You can explore the functionality available with both by signing up for a free developer account at https://developer.allscripts.com.


    Palani Kumar says:

    12/14/2016 at 2:26 am

    Well crafted FAQ for FHIR, although some might rise questions on Interoperability today I have no doubt that it’s the clear future. It can save millions of life, offer better healthcare and patient comfort. Adding more to that FHIR will considerably reduce healthcare costs and help patients and hospital survive in this competitive world.


    Palani Kumar says:

    12/14/2016 at 2:28 am

    Also if you are interested I would like to share our latest FHIR survey with you..! this survey includes top level healthcare management professionals (CEOs) to doctors. I think this would provide a good insight into FHIR and Understanding.


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