3. FHIR® USE CASES
FHIR® is built on the principle of providing a set of resources that when combined can enable faster and easier information sharing to support a range of administrative and clinical scenarios. Outlined below is three common examples of how FHIR® can support digital transformation across health and care services
PERSONAL HEALTH RECORD
The rise of patient empowerment has led to more citizens wanting access to their health records, whilst many are monitoring their health via fitness apps. This, in part, has seen demand for healthcare providers to implement Personal Health Records (PHRs) or add data to existing electronic health records (EHRs) from fitness or mobile devices, such as blood pressure monitors or ‘standalone’ tablet or phone apps. To achieve this, a new generation lightweight technology stack within the device is used which needs to send data to a variety of third party systems. Development time for these projects is typically short, compared with those traditionally associated with large healthcare integration projects.
The role of FHIR®
The communication needs to be standardised so that the consumer can connect to different vendor’s PHR and EHR systems according to their situation and location. FHIR® is the first healthcare exchange standard to be designed for the modern mobile-friendly tool set of REST and JSON (familiar to a new generation APIs of Google and Amazon). It allows data to be read, written and queried, providing all the flexibility to integrate a device or small PHR with a larger PHR/EHR.
FHIR®’s simplicity of use means a development team from the PHR or device community can use it rapidly, without needing to become experts in EHRs or health communication protocols. FHIR® has also standardised the use of well-known security and log-on standards, such as OpenID Connect, in a health records environment. This prevents each project from needing to reinvent this layer, potentially with design flaws.
Sharing medical documents such as test results, clinic letters or imaging and radiology scans can dramatically improve patient outcomes and coordinate care more efficiently. For these benefits to be realised a document sharing environment is required and is often based on IHE XDS standards. Unfortunately, this standard has no direct support for mobile devices, or modern REST interfaces, therefore limiting mobile access to these vital documents.
The role of FHIR®
IHE have now integrated FHIR® with XDS, to produce MHD (Mobile Health Documents) profile which allows mobile devices, and other resource-constrained systems, to use MHD to access to an XDS Repository. This has been built on top of common FHIR® resources that provide ways to create, store and reference documents of all kinds, for use with or without XDS/MHD. Beyond the capabilities of sharing traditional documents (such as PDFs), FHIR® also provides structured clinical document functionality for expressing all document-based uses cases, carrying on from and compatible with the highly successful HL7 CDA standard.
As healthcare digitisation continues to mature, the role of decision support is becoming more prevalent in everyday clinical environments. A key benefit of computerised structured medical records is the ability to provide automated expert input to the business process (e.g. drug interaction checking). Despite being widely deployed, the functionality and knowledge bases may be limited to use with one system or vendor.
The role of FHIR®
FHIR® has support for common decision support interactions, between separate systems, and can expose the necessary analysis data in standard format. This enables collaboration and plug-and-play of decision support providers and clients. FHIR®’s open set of resources is ideal for this purpose and has been used in the CDS Hooks2 standard from Boston Children’s Hospital in the United States.