Interoperability in Healthcare: Benefits of FHIR

The FHIR^® (Fast Healthcare Interoperability Resources) IT standard, developed by HL7^®, has been a transformative force in the healthcare sector since its introduction in 2014. This standard enables healthcare providers to access and share patient data in real-time, thereby reducing errors, improving clinical decision-making, and optimizing processes for more efficient patient care. Smooth communication between different systems relies on interoperability, encompassing both administrative and clinical information. This raises the question: What are the specific benefits of FHIR^® in data exchange?

Challenges of interoperability in health data exchange

The exchange of health data presents unique challenges due to the highly sensitive nature of this information. Any mismanagement or errors in handling it can lead to significant consequences, including breaches of patient privacy and compromised care quality. Here are some challenges of interoperability in the healthcare sector:

• Data inconsistency: Health data is often stored in different formats that may be incompatible with one another. Systems need to be able to access and interpret the data effectively. For example, there are differences between distinct specialized fields and domains, such as medical imaging and labs. Also, different institutions have different standards and definitions in their data workflow. This inconsistency complicates data exchanges hindering collaboration and continuity of care.
• Compliance with data privacy laws: Compliance with data privacy laws is paramount when exchanging sensitive information, such as electronic health records. Therefore, standards must include mechanisms to enable new applications to align with data protection and privacy laws.
• Volume of data management: Hospitals generate vast amounts of data, including patient information, internal system data, and information from medical devices. This data must be processed and transferred systematically and efficiently to prevent overflowing the system.
• High costs of complex systems: Complicated interoperability systems come with high costs for trainings and implementation. Stakeholders need to be willing to invest resources to ensure their systems can communicate effectively and that their staff understand how to develop, implement, and use these systems. Understanding these challenges is essential for developing robust solutions that ensure safe and effective data sharing. In this context, FHIR^® emerges as a powerful standard designed to address these issues, offering a framework that enhances interoperability while safeguarding patient information.

How FHIR^® enhances interoperability in healthcare

FHIR® is a standard created by HL7^® (Health Level Seven International). It is built on an open-source license, promoting free availability and accessibility for all stakeholders in the healthcare ecosystem. FHIR^® is based on web technologies such as JSON, HTTP, and XML, which are commonly used for technical communication in web apps. Its requests and searches are performed by common RESTful HTTP requests. Another key asset of FHIR^® is its emphasis on human-readable information as the foundation of interoperability, ensuring that data can always be shared and presented in an understandable format, even if machine-readable interoperability fails.

Benefits of FHIR^®

As a standard for healthcare interoperability, FHIR^® comes with several advantages:

1. It’s easy to learn, easy to implement, and easy to debug. And it comes with an active
   community.
   The organization behind the development of the FHIR^® standard, HL7^® (Health Level Seven), has two decades of experience in creating standards for health data. Taking a collaborative approach, it aims to establish a common foundation of resources that can be utilized by as many stakeholders as possible in the healthcare ecosystem. There are numerous tools, APIs, and examples that simplify and accelerate implementation of FHIR^®, and there is a very active community that meets regularly at Connectathons, sharing insights and use cases. The use of widely applied technologies also facilitates the search for qualified developers.
   
2. FHIR® is scalable, flexible, and license-free.
   That is why FHIR^® is set to significantly influence communication in healthcare in the future. Its applicability ranges from very simple to highly complex. FHIR^® resources (defined units of information such as “patient” or “medication”) consist of structured data attributes designed to cover 80% of typical application scenarios. They were only included when it was anticipated that at least 80% of all implementations using this resource also utilize the attribute. This approach ensures that the most frequently used attributes are inherently part of the resource. However, it is possible to represent additional content through extensions for application scenarios beyond the standard use cases, providing the opportunity to address specific requirements. FHIR^®’s great flexibility allows for various use cases, and being license-free and open-source further enhances its accessibility for stakeholders across the healthcare ecosystem.
   
3. It facilitates work across different institutions and provides a more comprehensive
   view of patient data
   In many cases, physicians need a full patient history to make their assessment, but don’t always have it available in a paper-based or not fully digitized world. FHIR^® addresses the challenges of incomplete or fragmented patient data. It is designed to link all relevant data and provide a complete overview for new stakeholders to enable the best possible care. FHIR^® also supports standardized formats and structures, as well as unified terminologies, which enhances access throughout different institutions.
   
4. Existing systems do not need to be redeveloped – FHIR^® integrates information
   appropriately
   This is basically the main function of the FHIR^® standard: to be used in conjunction with mobile applications, EHR systems, cloud communication, and between institutional healthcare providers. A FHIR^® API server can be added to access and translate existing systems and databases, eliminating the need for system redevelopment. To precisely address different
   existing and emerging use cases, FHIR^® offers profiles that define rules that apply to the resources. Given that each national health sector is heavily regulated, regional user groups, such as HL7^® Deutschland e.V., can tailor profiles to comply with national laws and regulations. In addition, organizations and project teams can also create custom profiles.
   
5. Patients could gain more data sovereignty
   For patients, the digitization of the healthcare system envisions a future where they can access multiple healthcare facilities using a single, consolidated health record. In Germany, the electronic patient file (ePA) has been gradually introduced since January 2025. In this context, there are approaches using FHIR^® to make structured data, the medical information objects (MIOs (e.g., laboratory findings, vaccination records), accessible in the ePA. That way, patients can access this data in the respective health insurance company app on their mobile devices. In Germany, these innovations are regulated, for example, by the Health Data Utilization Act (GDNG), which came into force in 2024.

Light the FHIR: Taking the first steps towards interoperability

As digitization expands and health data becomes more complex, the demand for interoperability in the healthcare sectors will persist and even intensify. Bridging differences in workflows, diverse data collection methods, cross-institutional patient identification, and heterogeneous application scenarios presents a significant challenge. However, the Benefits of FHIR^® enable the efficient exchange of disparate health data – benefiting health authorities, insurance companies, and hospitals alike. At Fraunhofer IIS, we are happy to assist with FHIR^® implementation consulting and assist in developing a FHIR^®-supported medical application.

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