The Ultimate Guide to Understanding the FHIR Standard

This guide provides healthcare professionals and organizations with the essential knowledge and tools to harness the power of FHIR to improve patient care and data accessibility in the evolving healthcare landscape

  • FHIR Fundamentals: Understand the core of FHIR in healthcare and its importance for sharing data.
  • Healthcare Necessity: Explore why FHIR is essential for healthcare organizations to enable improved data exchange and patient care.
  • Real-World Impact: Discover the practical benefits of FHIR through key use cases that demonstrate its transformative potential.
  • Implementation Insights: Identify the challenges of adopting FHIR and migrating data from HL7 V2.
  • Future Outlook: Gain insight into FHIR’s promising role in shaping the future of healthcare.
  • Sigma’s Solution: Explore Sigma’s customized FHIR solution for streamlined healthcare data interoperability.

What is FHIR in Healthcare?

The Fast Healthcare Interoperability Resources (FHIR) is an HL7 healthcare interoperability standard that enables disparate systems to exchange healthcare data using established data representations. These data representations in FHIR are clear and simple, accessible to both humans and computers, and strong enough to transfer complicated medical data when combined.

FHIR is designed to be adaptable, scalable, and easy to deploy. It uses modern web technologies such as REST (Representational State Transfer) and JSON (JavaScript Object Notation) to enable fast and effective communication between systems.

It’s similar to the software that takes a person to the right page when they type something into a Google search field. Standard URLs ensure that users can access the same website regardless of the operating system or device they’re using. FHIR has the potential to become the standard URL for the healthcare industry.

Why do Healthcare Organizations Need FHIR?

Traditionally, health information systems used by providers, hospitals, laboratories, and pharmacies have been siloed and weren’t designed to communicate data quickly or easily. Medical information about individuals has been fragmented due to a lack of interoperability between different health IT systems and a lack of data standards.

FHIR Standard in Healthcare

As a result, an individual’s information profile is presented differently in each organization’s system, leading physicians to attempt to make clinical decisions based on patient data that is incomplete, inaccurate, or inconsistent. Since physicians need comprehensive, accurate information to make treatment decisions for their patients, this is obviously a problem.

To ensure that data is easily sent and received across multiple healthcare systems, HL7 FHIR aims to promote and simplify the secure exchange of data between the many healthcare applications used by different vendors. FHIR is required because it streamlines implementation and ultimately increases the likelihood of interoperability by leveraging existing principles and processes.

The Benefits of FHIR for Healthcare Providers

Improved Patient Care

FHIR improves patient care by enabling the easy, real-time use of health data. This complete, up-to-date view of a patient’s health data helps healthcare practitioners make informed, timely decisions that lead to better patient outcomes.

Improved Data Access and Sharing

FHIR’s resource-oriented strategy and use of RESTful APIs make medical data more accessible and easier to transfer across platforms. This improved data visibility and interoperability can help improve medical management and reduce redundant tests and treatments.

Workflow Optimization

By simplifying the exchange of healthcare data, FHIR offers significant benefits in reducing workflows and increasing productivity throughout medical facilities. By reducing organizational constraints, healthcare workers can spend more time caring for patients.

Web and Mobile Application Support

FHIR is the best option for creating online and mobile applications because it is compatible with current web technologies. By enabling easy communication with healthcare professionals and access to personal health information, this compatibility improves patient engagement.

Innovation and Development just got easier

FHIR’s adaptable and easy-to-use health information exchange structure opens the door to medical innovation and advancement. This structure enables the development of unique tools and services to improve patient care and streamline healthcare operations, supporting continuous innovation and improvement in healthcare.

Regulatory Compliance

With a growing regulatory emphasis on data interoperability, implementing FHIR can help healthcare organizations comply with laws such as the CMS Interoperability and Patient Access Rule. This can help organizations avoid fines while maintaining a good reputation in the medical community.

Community Support

FHIR is supported by a large international community of healthcare and IT professionals because it is a freely available standard created by HL7. This community provides helpful materials, guidance, and support for the implementation and use of FHIR, making it a trusted and sustainable option for healthcare data exchange.

Five Use Cases of FHIR in Healthcare

In addition to well-known EHR companies like Epic and Cerner, industry titans like Google and Microsoft are embracing FHIR. Let’s take a look at the cutting-edge use cases that illustrate FHIR’s potential.

The Joint Commission

The Joint Commission is an organization dedicated to creating the standards, methods, and resources needed to improve quality assurance, especially those that impact patient safety. The FHIR standard is being used to extract and capture high-quality metrics from member organizations using a special data format designed to express medical quality data (the Health Quality Measures Format, or HQMF). The organization intends to extend on an early HL7 initiative in which quality metrics can be defined via FHIR. This will require the ability to transfer health quality measurement data via FHIR as well as the ability to define analytic algorithms in FHIR.

Apple Health Records

Apple Health Records uses FHIR standards to provide iPhone users with instant access to EHRs. By combining data from multiple healthcare providers, it creates a comprehensive and up-to-date medical summary for an individual. It includes important information such as medical conditions, immunizations, test results, prescriptions, and vital signs.

CoxHealth and SMART on FHIR

CoxHealth, a healthcare organization based in Missouri, is using an FHIR-powered application to provide more accurate diagnoses. Clinicians can use medical imaging, visualization, and machine learning through an application called VisualDx that runs on SMART on FHIR. This helps them compare known variants of certain diseases that affect the skin, hair, and nails to diagnose patients more accurately.

The SMART architecture enables applications that can be used across healthcare systems and by professionals, patients, and others. The U.S. government helped develop the open, free, standards-based SMART on FHIR API. It allows developers to build applications once and use them across the healthcare system.

Science for Sync (S4S)

The National Institutes of Health (NIH) launched the Sync for Science (S4S) initiative to facilitate data synchronization for scientific studies. By making data exchange between people and researchers simple and secure, the initiative hopes to advance precision medical research.

FHIR Implementation Challenges

Security and Privacy Issues

FHIR’s enhanced data exchange capabilities raise important questions about the security and privacy of private patient information. It is extremely difficult to balance the need to protect patient information with the convenience of interoperability. Healthcare organizations must have strong security measures in place, such as secure data transmission and storage, and efficient patient consent management.

Time and Cost-Consumption Mapping

Professionals “map” data whenever there is a need to match fields from one database to another. In the case of FHIR requirements, data is mapped to FHIR resources. For example, suppose a patient resource is stored in a database in one format but needs to be in the FHIR format. There are two ways to approach this problem. The first option is to engage a team of data analysts to do it manually, but this would be a time-consuming and costly operation. The second is to use an FHIR mapper tool to automate the process of mapping healthcare data to an FHIR resource.

Standardization and Semantic Interoperability Challenges

Although FHIR provides a standard for data exchange, discrepancies in data definitions and interpretations can still cause problems, known as semantic interoperability issues. A key issue is ensuring that each system perceives and interprets data in the same way. This requires mutual understanding and acceptance of the meaning and implementation of information.

FHIR Validation and Reference Management

With an enormous amount of data comes a variety of data challenges, such as duplicates and lookups. It is critical to address issues with patient matching, practitioner matching, and claims data matching. Maintain connections between transformed FHIR resources, such as patient and physician encounters.

Legacy System Integration Issues

Many healthcare organizations rely on legacy systems for everyday tasks. Integrating FHIRE, which is based on the latest Web standards, into these systems can be difficult. Overcoming this obstacle often requires major transformation efforts and potential disruption, requiring careful preparation and deliberate allocation of resources.

Loading Terabytes of FHIR Data

Another issue that can arise is the large volume of data that must be translated into the FHIR format. This is easily overcome by using a powerful conversion tool and cloud technologies.

Future of FHIR in Healthcare

In global healthcare, big data is big business. According to RBC Capital Markets, “the compound annual growth rate of healthcare data will reach 36% by 2025.”

As the volume of healthcare data grows, hospitals, medical professionals, and public health organizations must improve their ability to securely communicate this data to address potential emergencies such as infectious disease pandemics,  cancer, cardiovascular disease, and suicide.

The U.S. federal government is responding to the need. In December, the Centers for Medicare & Medicaid Services (CMS) proposed the Advancing Interoperability and Improving Prior Authorization Processes rule, which calls for payers to establish APIs to share patient health information-definitions or procedures that allow two pieces of software to interact with each other. The proposed solution, according to the rule, is to use FHIR to foster an API ecosystem based on open industry standards across the healthcare value chain.

FHIR enablers and converters are the future of seamless implementation of the FHIR standard. One of the biggest challenges in implementing the FHIR standard is the large number of different data formats, each with its own difficulties. For example, let’s take a look at the Health Level 7 (HL7) Version 2 data format.

Converting data from HL7 V2 to FHIR can be challenging due to differences in data models, message formats, and semantics between the two standards. Here are some common difficulties encountered during this conversion process and strategies to overcome them:

  • Semantic Differences:
    • Difficulty: HL7 v2 often uses implicit semantics, while FHIR relies on explicit semantics defined within resources. This means that mapping the meaning of data elements from HL7 v2 to FHIR can be complex.
    • Solution: Develop clear mapping documentation that defines the meaning of each data element in HL7 v2 messages and how it translates to FHIR resources. Use FHIR profiles and extensions to capture specific semantics as needed.
  • Data Element Mapping:
    • Difficulty: HL7 v2 messages have their own set of segments, fields, and data types, while FHIR uses a different resource-based structure. Accurately mapping these elements can be challenging.
    • Solution: Create detailed mapping tables that specify how each HL7 v2 segment, field, or data type corresponds to FHIR resources and elements. Consider using automated mapping tools where appropriate.
  • Data Repetition:
    • Difficulty: HL7 v2 allows repeating segments and fields within a message to represent multiple occurrences of related data. FHIR handles repeating data differently through lists or arrays within resources.
    • Solution: Design your FHIR resources to accommodate repeated data using appropriate FHIR elements (e.g., repeating observations). Ensure that the mapping process accurately captures repeated data and maintains relationships between related elements.
  • Customizations:
    • Difficulty: Healthcare organizations often customize HL7 v2 message structures to meet their specific needs. These customizations may not have direct equivalents in FHIR.
    • Solution: Document and analyze customizations in HL7 v2 messages. Determine how to represent custom data within FHIR using extensions or additional FHIR resources. Custom transformation logic may be required to handle non-standard elements.
  • Event-Based Messaging:
    • Difficulty: HL7 v2 messages are often event-driven, reflecting specific healthcare events. FHIR represents data as resources that can be queried and updated independently.
    • Solution: Develop a strategy for translating event-driven HL7 v2 messages into FHIR resources. Consider using FHIR’s resource history and versioning capabilities to maintain event information. Develop logic to appropriately handle FHIR CRUD operations.
  • HL7 Version Variants:
    • Difficulty: HL7 v2 has multiple versions with differences in message structures and standards. Converting data from different HL7 v2 versions to FHIR may require version-specific mapping.
    • Solution: Develop version-specific mapping guides that address the differences between HL7 v2 versions and FHIR. Use conditional logic in your transformation process to handle version-specific variations.
  • Error Handling:
    • Difficulty: HL7 v2 messages often include error segments (ERR) to convey error information. FHIR uses HTTP status codes and response structures for error handling.
    • Solution: Develop a mapping strategy to translate error information from HL7 v2 messages to FHIR error responses. Ensure that error codes and descriptions are accurately represented in FHIR responses.
  • Testing and Validation:
    • Difficulty: Ensuring the accuracy and completeness of the conversion process can be challenging.
    • Solution: Implement thorough testing and validation processes. Validate converted FHIR data against real-world scenarios, sample HL7 v2 messages, and expected outcomes. Use FHIR validation tools to ensure compliance with the FHIR specification.
  • Documentation and Training:
    • Difficulty: Effective documentation and training are critical to successful transitioning from HL7 v2 to FHIR.
    • Solution: Create comprehensive documentation that includes mapping guides, data dictionaries, and transformation logic. Provide training to staff involved in the conversion process to ensure a common understanding of the mapping rules and processes.
  • Iterative Approach:
    • Difficulty: Converting large amounts of data can be a time-consuming process.
    • Solution: Take an iterative approach by converting and testing data in smaller, more manageable batches. This allows for incremental improvements and adjustments to the mapping process.


Overcoming these difficulties in converting HL7 v2 to FHIR requires careful planning, documentation, and collaboration between healthcare IT professionals, domain experts, and developers. It’s important to maintain data quality, accuracy, and semantic integrity throughout the conversion process.

Each data format will have its own set of difficulties in the conversion process. The simplest and most cost and time-effective solution is to use an FHIR converter to transform different types of data into the FHIR standard.

Sigma Software’s Cloud-Native Solution for FHIR

Sigma Software has extensive experience in the healthcare industry. Our solution is helping to move the FHIR standards community forward. We strive to make FHIR easier to implement.

We believe that using a cloud FHIR implementation can help you overcome some of the barriers associated with adopting FHIR and developing an FHIR-based service.

Software Engineering

Need help with adopting FHIR and developing an FHIR-based service for your organization?
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The ideal cloud solution will allow you to deploy your environment quickly, customize it, and scale it as needed-all while limiting costs.

Benefits of Sigma Software’s Cloud-Native Solution Include:

  • Rapid FHIR adoption: Configuring infrastructure resources in the cloud can take seconds. With the virtual infrastructure of the cloud, you can greatly accelerate FHIR adoption. It can take months to acquire, deploy, and configure infrastructure in your own data center.
  • Cost-effectiveness: Cloud-based FHIR services are less expensive than on-premises alternatives. You can quickly grow or shrink your cloud environment as your data and processing volumes fluctuate.
  • Constant availability: With an Internet connection, you can use cloud-based FHIR solutions anywhere, anytime.
  • Scalability: Cloud-native solutions can be easily scaled up or down as needed. This flexibility is essential for healthcare providers whose data and processing needs can change over time.
  • Access to Advanced Technologies: By choosing a cloud-based FHIR implementation, you can take advantage of the unique capabilities offered by cloud providers. For example, integrating cloud-based machine learning (ML) models can provide new insights for medical decision-making.
  • Resilience and Reliability: Cloud-native architectures often include built-in redundancy, ensuring that services remain available even if certain components fail.
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