FHIR Implementation Guide

FHIR Implementation for Interoperability Success in Healthcare


Healthcare interoperability has long been a challenge due to the vast amount of sensitive data and stakeholders involved. Furthermore, concerns about data accuracy, security, and privacy have made interoperability a prominent topic in the healthcare sector. However, the emergence and widespread adoption of Fast Healthcare Interoperability Resources (FHIR) have addressed many of these concerns.

FHIR has gained traction in the healthcare industry relatively recently, and although many providers have already implemented FHIR for achieving interoperability, its use cases remain limited. Consequently, individuals without prior experience in building interoperable systems may encounter significant challenges and potentially make critical errors.

Cures Act Update: What is Current State of FHIR Adoption

The ONC Cures Act Final Rule is a comprehensive regulation that aims to create a more accessible and interoperable healthcare system, benefiting patients and healthcare providers. It is a component of the 21st Century Cures Act, which was passed in 2016 with the goal of accelerating medical research and streamlining drug approval processes.

The Cures Act places a strong emphasis on implementing application programming interfaces (APIs) that enable easy access to information from medical records and certified IT products. The HL7 Fast Healthcare Interoperability Resources (FHIR) standard has emerged as the leading API for health data exchange and has gained global recognition. The Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare & Medicaid Services (CMS) have mandated the use of FHIR v4 as the standard to fulfill the requirements of the 21st Century Cures Act.

The Cures Act's focus on interoperability and the adoption of FHIR standards present exciting opportunities for the healthcare industry, with the potential for significant improvements in data exchange and healthcare delivery.

What can Healthcare Providers Expect from FHIR API Standardization in 2023?

The healthcare industry is currently witnessing a growing trend towards adopting the standard Both patients and providers are eager to leverage the advantages of this standardized platform. However, some providers have been slow in integrating the FHIR API into their EHR workflows.

In cases where the standard FHIR API is not already available in a provider's EHR system, it is advisable for the provider to inquire with their vendor about its availability. While it may take some time to implement this API, it is expected that by the third quarter of 2023, healthcare providers involved in payment regulations will be required to have it integrated into their certified electronic health record technology. If a provider is currently using a certified EHR that lacks a standard FHIR API, it is advisable to inquire about the vendor's intentions to enable involvement in contemporary digital healthcare.

The ONC FHIR Certification Program establishes distinct criteria for certified health IT developers. ONC Certified Health IT developers are required to:

  1. Enhance interoperability for patients and providers by utilizing FHIR-based application programming interfaces (APIs).
  2. Facilitate access to consistent data elements, as defined in at least version one of the United States Core Data for Interoperability (USCDI), for patients, providers, and other stakeholders.
  3. Enhance the reliability and comprehensiveness of ePrescribing.
  4. Offer transparency to stakeholders by outlining how Certified Health IT Developers conduct real-world testing of their technology through Real World Testing plans.

RELATED: United States Core Data for Interoperability (USCDI): Advancing Healthcare Interoperability

As per an ONC HealthITBuzz blog post, more than 95 percent of certified health IT developers met the compliance deadline set by the Cures Act Final Rule to provide customers with new technology. As compliance deadline has passed, the focus now shifts to monitoring adoption and conformance to ensure the effective implementation of the FHIR standards.

Why is FHIR so Popular?

RESTful API Integration

FHIR utilizes RESTful API, making integration with web-based applications, mobile applications, and digital health tools seamless. It enables efficient communication and data exchange between different systems.

Support for Various Healthcare Data Types

FHIR supports a wide range of healthcare data types, including clinical observations, diagnoses, medications, and more. This ensures consistent and easy access to patient data across different systems, improving data interoperability.


FHIR resources can be easily customized to meet the specific needs of healthcare organizations. It offers flexibility in data exchange and allows for adaptation to local requirements, enhancing system interoperability and usability.

Patient-Centric Approach

FHIR follows a patient-centric approach, empowering individuals to access their health data from multiple healthcare providers. Patients can manage appointments, view their health information, and even share data with other apps and services, enabling greater control and engagement in their healthcare journey.

Predictive Analytics

FHIR-based standards enable advanced analytics capabilities, allowing public health officials to analyze data and identify trends for better population health management. Predictive analytics helps in predicting health outcomes, facilitating early interventions, particularly for populations with chronic diseases or behavioral health needs.

Enhanced Surveillance

FHIR supports enhanced surveillance by refining and deploying evolving case definitions. Public health officials can quickly respond to emerging health threats by analyzing data from various sources, such as notes, medication orders, and lab results. Spatial clustering and temporal predictions further aid in effective monitoring of disease outbreaks.

Personalized Communications

FHIR enables personalized communications in healthcare. Care providers and patients can receive customized healthcare messaging based on their specific health needs. This includes reminders for appointments, medication adherence, and adopting healthier habits, tailored to individual patient profiles.

Streamlined Data Sharing and Privacy

FHIR-based standards facilitate streamlined data sharing while preserving patient privacy. Access to data is controlled based on authorized levels, ensuring efficient and secure data exchange among healthcare stakeholders. This capability is crucial in today's fast-paced healthcare environment for improved patient outcomes.

FHIR works on AWS

FHIR Works on AWS is a framework designed for deploying a customized FHIR server on the Amazon Web Services (AWS) platform. It allows users to add and adapt different FHIR functionalities based on their specific needs and use cases. The framework provides a flexible and robust solution for building and tailoring FHIR servers within the AWS environment.


SMART on FHIR allows for seamless integration of third-party applications with electronic health records (EHRs) and other healthcare systems. SMART on FHIR incorporates OAuth2-based authorization and security mechanisms.

By harnessing these features and benefits, FHIR enhances interoperability, patient engagement, and data-driven decision-making in the healthcare domain.

RELATED: How Mirth Connect Supports the Latest Health Data Standard FHIR

How FHIR helps to Overcome Interoperability Challenges

  1. Difficult Vocabulary and Terminology

    Healthcare data often includes complex and difficult-to-understand medical terminology. In the absence of standardization and uniformity in medical vocabulary, different systems and applications may interpret the same terms differently, creating confusion and potentially leading to inaccurate or incomplete data exchange.

    FHIR addresses this issue by incorporating standardized medical terminologies and vocabularies, promoting consistency and accuracy in data exchange. By utilizing these standardized terms, FHIR minimizes the risk of misinterpretation and simplifies care delivery processes, making them less complex and more efficient.

  2. Patient Matching

    The accurate identification of patients across various healthcare systems and providers can be challenging due to the storage of patient information in different formats and systems. This often leads to inconsistencies and errors in patient matching, resulting in duplicate patient records, missed diagnoses, and delayed treatment. This issue is a significant concern for healthcare providers worldwide.

    FHIR addresses this challenge through its patient matching algorithm. By leveraging this algorithm, FHIR facilitates the identification and matching of patients across different healthcare systems and providers. This helps to minimize the risk of duplicate patient records and ensures that diagnoses are not missed due to incorrect patient matching.

  3. Interoperability Testing

    Interoperability testing is a complex and time-consuming process, as it involves evaluating the compatibility and interaction between different systems and applications. However, a major challenge lies in the absence of standard testing frameworks, causing vendors to use diverse methods and tools, resulting in inconsistent testing results.

    To overcome this challenge, FHIR introduces a standardized testing framework. This framework enables consistent and accurate testing of interoperability between various systems and applications.

  4. Regulatory Frameworks

    Regulatory frameworks and healthcare certifications play a crucial role in healthcare, impacting the cost, quality, and practice of medicine. However, these frameworks can vary significantly between countries and regions, posing challenges in developing interoperability solutions that align with diverse regulations. Furthermore, health regulatory bodies are often slow to adapt to rapid advancements in healthcare technology.

    FHIR addresses these challenges by being designed to comply with existing regulations, such as HIPAA in the United States. This feature enables healthcare organizations to develop interoperability solutions that align with regulatory frameworks, facilitating the secure and compliant exchange of healthcare data.

  5. Data Governance

    Healthcare organizations must adhere to strict data governance policies and procedures, which define data ownership, access, and usage. When multiple organizations exchange electronic healthcare information for patient care, there is a heightened risk of data loss or mishandling. Effective records management includes policies and procedures for access authorization and auditing to regulate data access.

    FHIR provides strong data governance capabilities, including access control and auditing mechanisms. These features help ensure that healthcare data is securely and appropriately managed and exchanged, minimizing the risk of access or improper handling of sensitive information.

FHIR Implementation Use Cases

Unsure if FHIR implementation in healthcare is relevant to you? Understanding common use cases can demonstrate how adopting FHIR can revolutionize your business. In general, FHIR is utilized for:

  1. Developing comprehensive patient portals accessible on various apps and devices.
  2. Facilitating the sharing of medical charts and documentation for insurance claims processing.
  3. Enabling teams to collaborate and access personal health records for enhanced care.
  4. Utilizing cloud and AI technologies to create solutions with predictive analytics and automation.
  5. Designing decision support applications for early warning systems, treatment plan identification, and more.

Now, let's explore specific FHIR implementation use cases in more detail:

  1. E-Referrals Automation

    A healthcare software provider integrated its cloud platform with multiple EHR software providers, hospitals, and physicians to comply with the 21st Century Cures Act. Adhering to FHIR specifications enabled secure and standardized data exchange, automating the generation of e-referrals. By adopting HL7 FHIR, the provider streamlined workflows for healthcare professionals and simplified patient management tasks through automated e-referrals across different EHR systems.

  2. Staff Performance Optimization

    A US healthcare system faced staffing problems due to a scarcity of dermatologists, causing primary care physicians to perform dermatology exams. This resulted in reduced efficiency and quality of care. To overcome this challenge, the provider adopted an FHIR-powered app connected to the EHR system. The application empowered doctors, including dermatologists, by offering decision-making support. By leveraging medical imaging, visualization, and machine learning, the app provided potential diagnoses based on patient data. This led to improved diagnostic accuracy and enhanced performance of the primary care physicians.

RELATED: FHIR API Implementation: 12 Key Checkpoints

FHIR Implementation Challenges

integration and data interoperability standards can be complex and present challenges for healthcare systems that are new to them. These challenges include:

  1. Complex Interface Programming

    Connecting two systems requires significant programming knowledge and understanding of both systems. Ongoing monitoring and testing are necessary to ensure the interfaces function properly without disruptions.

  2. Time and Resource Requirements

    Implementing FHIR-compliant systems is a complex process that requires effort and time. Achieving interoperability involves multiple steps, from ensuring interconnectivity in each app to altering organizational interoperability. Thoroughly studying the current system and investing in research are necessary for successful FHIR implementation.

  3. Tailored Integration for Specific Business Needs

    FHIR-compliant systems not only optimize technical aspects but also align with business objectives. Effective business analysts are essential, especially for third-party administrators (TPAs) in the healthcare industry. Each organization's unique business logic and data formats must be considered, resulting in additional complexities during FHIR integration.

  4. Security Concerns

    Implementing FHIR healthcare services may require reevaluating security procedures, even if HIPAA compliance is maintained. Sharing access to system data introduces vulnerabilities and presents new security challenges. Ensuring data confidentiality while mapping and transferring data is a concern. Configuring multi-tenant models with extensive functions, roles, and permissions becomes more challenging.

  5. Lack of Technical Expertise

    Due to FHIR being a relatively new standard, there is a shortage of individuals experienced in setting up FHIR cloud platforms and working with FHIR APIs. Healthcare organizations often face difficulties finding qualified internal specialists and may seek external assistance from software development companies with relevant expertise.

  6. Data Uniformity in Third-Party Applications

    Establishing FHIR APIs requires data manageability and consistency across connected third-party software. Until data records are standardized and in the same format, seamless interchangeability of cloud FHIR systems is challenging. Managing reliable data and addressing potential data problems, compliance metrics, and data remediation processes are crucial tasks.

How KPi-Tech can Help Implement FHIR

Implementing FHIR interoperability in healthcare systems as seen abvove is a complex and challenging process, requiring significant investment in time, resources, and technical expertise. However, with the help of an experienced FHIR service provider, organizations can adopt new features and maintain compliance while receiving ongoing support.

KPi-Tech is a Healthcare IT company focusing on interoperability solutions. We have software engineers with prior experience adopting HL7 standards, including FHIR. They can assist you with a specific task or take full responsibility for the project. You choose the scope of involvement and services.

Overall, we can:

  1. Consult you on how to achieve FHIR interoperability after analyzing your existing system
  2. Outstaff our engineers to assist with practical tasks like optimization or integration
  3. Assemble a dedicated team for you that will help build interoperable systems from scratch

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