Healthcare Interoperability Gets a Boost with the Release of HL7’s FHIR R4

Health Level Seven’s latest iteration of its Fast Healthcare Interoperability Resources standard promises to offer a more normative approach.

Early in 2019, Ann Arbor, Mich.-based nonprofit Health Level Seven released its newest version of the Fast Healthcare Interoperability Resources standards framework, which promises to lay the groundwork for improved interoperability.

For those who aren’t familiar with FHIR, it’s a draft standard and application programming interface that, when adopted, will enable the electronic exchange of healthcare information. It can be used across a wide variety of tools for patients and providers, including mobile devices, cloud, web applications and more.

Already, use of FHIR is growing steadily among healthcare providers and developers. According to data published by the Office of the National Coordinator for Health IT in October 2018, 32 percent of health IT developers are using FHIR R2. Meanwhile, 51 percent of developers are using a version of FHIR combined with OAuth 2.0, an open standard for secure access delegation among online resources.

MORE FROM HEALTHTECH: Everything you need to know about SMART on FHIR.

FHIR R4: A More Normative Approach

What’s the biggest change in the new version?

With Release 4 (FHIR R4), “the base platform of the standard has passed a normative ballot and will be submitted to the American National Standards Institute (ANSI) as a normative standard,” according to a post on HL7’s official blog, The Standard. Moreover, with this change, future versions of FHIR will be backward compatible, meaning that applications implementing normative sections of R4 won’t risk nonconformance with the standard.

Specifically, the following parts of RF are now normative, according to The Standard:

  • The RESTful API, the XML and JSON formats, and the basic data types
  • The Terminology Layer (CodeSystem and ValueSet)
  • The Conformance Framework (StructureDefinition and CapabilityStatement)
  • The key resources Patient and Observation

“FHIR Release 4 marks a significant milestone with the introduction of a normative base,” HL7 FHIR Product Director Grahame Grieve told The Standard. “This new maturity will help support our very active and growing community.”

Specifically, the newest version is more mature and helps to alleviate many of the worries associated with making future changes to software, Russell Leftwich, assistant professor of biomedical informatics at Vanderbilt University School of Medicine, told Health Data Management.

“Conformance with this normative base will mean that applications based on FHIR R4 will have a long life cycle and greater portability,” Leftwich added. “It will be easier to upgrade rather than replace such applications.”

MORE FROM HEALTHTECH: See why healthcare tech giants have banded together to support healthcare data.

What Will FHIR R5 Hold?

But HL7 is clear that this version’s changes are just a start. Already, the organization has noted that the next version, R5, will build on the latest release to expand normative content, enhance publishing implementation guidelines and improve support for apps that use multiple FHIR versions, among others.

HL7 FHIR R4 is a beginning,” HL7 CEO Dr. Charles Jaffe told The Standard.” It is a commitment from HL7 to create a platform from which Interoperability can someday emerge. It is a promise to provide reusable data across the continuum of biomedical research, patient care, and population health.”

Just what might those changes entail? Leftwich believes the standard’s usefulness will grow along with provider needs in Version 5 and beyond.

“We can expect that FHIR will continue to evolve with increasing value and utility to be realized in each release,” he says. “I would compare this new concept of standards evolution to the evolution of other technology that we have become familiar with. For any particular brand of smartphone, there is never a final version — they just continue to evolve and improve. Similarly, with Bluetooth or Wi-Fi, the next version is better — more useful — but there is not going to be a final version.”

ChakisAtelier/Getty Images
Jan 23 2019

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