HSWT

FHIR (Smart?)

There is a fair amount of information out there about FHIR at this point, although I have admittedly found many of them less than completely helpful. Someone recently told me they thought the reason Docker has been so successful is that they have really good documentation on their website. So in that spirit, I'm going to write down some of my thoughts here, and help educate myself in the process (and maybe help any others that are in the same boat). So I'm going to consolidate some of my thoughts here. Electronic Health Records (EHRs, previously EMRs) don't talk to each other. This is stupid for patient care. But it's good for the EHR Vendors. The more your data is secured inside their system, the more difficult it is for you to leave them. And they make lots of money from this (1, 2, 3, 4, 5).

So to my limited knowledge (this article sums up the history pretty well). There was no standard for communication (or there was, it was just terrible). And there are two standards that have been developed to help us. The first is SMART (Substitutable Medical Applications and Reusable Technologies). SMART was initially going to be the data standard. But it has changed and is now focused on interacting with FHIR interfaces, detailing how apps will be "launched" from an EHR, and standardizing security protocols between apps and an EHR.

So then what is FHIR? Stands for Fast Healthcare Interoperability Resources. It is the standard data format for exchange between apps and EHRs (or possibly EHRs and other EHRs). Developed and maintained by HL7 (Health Level Seven International). Also, FYI, the two above together are referred to as Smart on FHIR.

There are lots of technical issues here, most of which I don't understand well, but may explore a bit in future posts. The one I'm going to start with is some basic documentation on using these, if I can figure out enough to explain it. My basic interest is in using FHIR as a store of data, and building apps on top of it (so it's in a format that is well known, documented, can be expanded, ported over, or, in my wildest dreams, made into a new EHR in the future - shhhhhhh! don't tell anyone).

So where to begin? That's a good question. How about some structure.

1. FHIR Resources

   • basic unit of information

   • Examples: Patient, Appointment, Medication, Practitioner

   • Parts of a resource

   • A resource consists of the following parts:

     • Metadata – technical/workflow info, e.g. version ID or last update time

     • Narrative – human readable description

     • Extension – information not in base implementation, added on locally

     • Elements – information about the Resource ( for Patient, examples are name, gender, birthDate, etc).

     • Data types – specific for each element. HumanName is the datatype for name, date is the datatype for birthdate.

Nope, I take it back. We're going to do the Smart part first, because you can't access anything if you don't have that. And it will be a new post so I can find it in the future.