Posted on behalf of Paul J. Actis, Vice President, Research & Development


fhir-healthcare-itThere’s a new integration standard in town, and it’s heating up the whole valley.
FHIR (Fast Healthcare Interoperability Resources) takes the best of the existing protocols (HL7 2, HL7 3, CDA…) and brings them into the modern world of healthcare integration.  FHIR presents a number of advantages over the current set*:

  •  A strong focus on implementation – fast and easy to implement (multiple developers have had simple interfaces working in a single day)
  • Multiple implementation libraries, many examples available to kick-start development
  • Specification is free for use with no restrictions
  • Interoperability out-of-the-box– base resources can be used as is, but can also be adapted for local requirements
  • Evolutionary development path from HL7 Version 2 and CDA – standards can co-exist and leverage each other
  • Strong foundation in Web standards– XML, JSON, HTTP, OAuth, etc.
  • Support for RESTful architectures and also seamless exchange of information using messages or documents
  • Concise and easily understood specifications
  • A Human-readable wire format for ease of use by developers
  • Solid ontology-based analysis with a rigorous formal mapping for correctness

FHIR’s closest standard, HL7 v3, did not gain wide acceptance, one of the reasons because of its design by constraintparadigm.   FHIR takes a totally different approach in using the 80/20 rule.   This states that inclusion of data elements (resources) which are most common under normal implementations will be part of the standard and any other custom content will be defined as extensions.


The healthcare interoperability industry is definitely taking FHIR seriously. Numerous initiatives seem to be sprouting daily.   The Argonaut project, SMART on FHIR and, Sync for Science just to name a few. FHIR is being used by over 20 countries and 150 organizations.
While FHIR is gaining broad acceptance, its biggest competitor HL7 v2, has been around for almost 30 years.   Its simplistic model and wide implementation base means v2 will be around for quite some time.  So don’t look for FHIR to replace it, but supplement it as market evolves to meet the needs of the new technology infrastructure.   Mobile, web services, and cloud-based applications is where FHIR’s strength will be most implemented.
FHIR, however, is still in its infancy. It is in its second rendition of Standard for Trial Use (DSTU).  The third draft is set for 2017 and Normative for some time in 2018.  During this time period before Normative, the FHIR specification is subject to change so that is something to be aware of as you are working through your own FHIR initiatives.

Summit and FHIR

As a leading provider of healthcare integration, Summit is committed to be at the forefront of this technology. FHIR is an integral part of our new web and exchange platforms.  Provider Alert implements numerous FHIR resources for its report generation process which will allow for quick onboarding of new document types.  FHIR fits in very well with Summit Exchange’s extensible architecture, providing another transport for data exchange without all the complexity.    FHIR can also be processed within our current Express Connect product.