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FHIR Status Check

 More than 2 years have past since I wrote my article on the Fast Healthcare Interoperability Resources (FHIR®) standard and it’s time to do a quick status check and revisit the predictions I made back then.

The FHIR standard continues the strong trajectory of adoption and is now used across the globe. The application programming interface (i.e. the FHIR API) is available in most major EHR systems today. According to the US Office of the National Coordinator Health Information Technology an estimated 85% of hospitals have FHIR in their systems. The NHS has been quick to adopt FHIR and the adoption curve in the UK is high. The NPfIT (NHS Care Record Service) HL7 V3 interfaces are being redeveloped in FHIR®, and new NHS specifications such as the CareConnect standard for secured Transfer of Care  are being specified in FHIR® by default.

Despite the industry enthusiasm about the potential of FHIR still the old and faithful HL7 v2 remains the predominant interoperability standard in use today and serves as the interoperability backbone in most health organizations. 

According to a recent HIMSS case study the use-cases for using FHIR are: enhancing consumer engagement (52%), improving payer-provider convergence (49%), bridging gaps-in-care (38%), regulatory compliance (37%) and provider engagement (25%).


It is my belief that the fact FHIR struggles to replace HL7 v2 is that the latter do an excellent job in event driven scenarios were information needs to be pushed from a source system to multiple destinations. This model of data - exchange perfectly suites common cases in healthcare such as patient flow and test results updates.

Being a RESTful standard the method to implement event driven interfaces is through a pub/sub mechanism via the use of webhooks.

FHIR is evolving, through an incremental process, each year. The current release 4 defines a subscription Resource which is FHIR implementation of webhooks. This recourse has a “Maturity level” of  3 out of 5 levels, which means that it has been verified by the work group, but not yet tested and published. 

Despite the hurdles yet to overcome for fulfilling the high expectations of the HCIT community I feel confident that FHIR will continue its strong adoption and  will eventually become the predominant interoperability standard in healthcare.


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