In the healthcare space, most clinical data standards are set by HL7. The process of creating a new standard, and releasing it to healthcare professionals and developers is difficult. The reason for this is due to variability of protocol standardization that often encompasses multiple versions. In an attempt to solve this problem, HL7 introduced FHIR® – Fast Healthcare Interoperability Resources, which is built around “Resources.” Resources are modular components that allow an easy and quick way for patients and doctors to access data. FHIR is providing a modern form of interoperability in the healthcare space, however there are still various drawbacks regarding versioning and inconsistent implementation.
The FHIR standard is continuously evolving and the FHIR revisions are often updated and iterated. It can be cumbersome to know which standard is currently implemented across EHR (electronic health records) vendors, and even harder to find helpful information. The timeline to fully implement a new standard is often long, and is dependent upon EHR vendors deploying FHIR updates in their software (a long process in itself). Presently, there is not much structure in EHR implementation, where often there is significant variability. The HL7 group is aware that FHIR standards are going to continually evolve, and in the long run impact the standard to limit variation in interpretation as the goal of FHIR is to allow for structurability and consistency. As you can imagine, with multiple EHR standards, that are all flexible in nature and have been implemented slightly differently across all EHR vendors, it is nearly impossible to stay up to date and solve the real issue at hand, true interoperability in clinical data; hence the birth of FHIR.
DSTU2, STU3 and the newest FHIR standard release, R4 are all extremely relevant today. The three versions of FHIR are important to understand, specifically that any service utilizing FHIR should support all three standards (all services at 1upHealth cover these formats). DSTU2, which stands for Second Draft Standard for Trial Use, was released October 24, 2015 with various updates from DSTU1, encompassing addition and removal of elements, updates to code elements, status, and many more. STU3, which means Release 3 Standard for Trial Use, was released February 21, 2017, was a full FHIR release encompassing over 2,400 changes. Examples updates include version management consolidation, improvements to resource definitions, technical changes to RESTful APIs, and many more. \n R4, Release 4, was released December 27, 2018 and is the new release that is composed of mixed resources that are normative and STU. R4 has normative content, meaning that some resources will not change and be flexible in the same way that they are in all the previous releases. This is massive news because adoption of R4 would create a true standard and another important step towards true interoperability. Examples of what was added as part of FHIR R4 are new elements like age, address, annotation, dosage, money, booleans, and more; further expanding the amount of data you are able to query.
For more information on FHIR fundamentals, history, use cases, and 1upHealth’s role in FHIR, visit our Introduction to FHIR