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The traditional manual recording of vaccination records in Germany faced challenges during the COVID-19 pandemic, prompting the introduction of a COVID smartphone app with QR codes. However, this solution brought new challenges, emphasizing the need for a centrally managed European digital vaccination record for efficiency and validity. This study assesses the feasibility of using the HL7 FHIR standard in the healthcare industry for implementing a digital vaccination pass management and monitoring system. The system aims to offer convenience and improved efficiency for both patients and healthcare providers while promoting interoperability with other healthcare systems. To this end, we developed a prototype using modern technologies, such as React, Quarkus, and Keycloak. Results indicate potential benefits for patients and healthcare providers, offering access to immunization records, personalized recommendations, and streamlined management. However, integrating nuanced vaccination processes into the standardized FHIR system requires custom extensions, which might hinder interoperability. Manual data entry and the integration of an identity provider present further obstacles in industry scenarios. Despite these challenges, this study suggests that implementing HL7 FHIR can enhance efficiency, data accessibility, and accuracy in the vaccination process, supporting broader digitization efforts in the German healthcare system and beyond. [ABSTRACT FROM AUTHOR]

Currently, the Taiwan Electronic Medical Record Exchange Center uses the Clinical Document Architecture (CDA) framework, which is based on the international medical standard. The CDA R2 standard, defined in 2005, is used for cross-institution retrieval of electronic medical records (Ministry of Health and Welfare, Information Department, 2021). However, CDA R2 only supports the exchange of clinical documents and is limited to the XML format. Due to the lack of a standardized framework for medical data exchange in Taiwan, different standards and specifications result in different data interface methods between systems, requiring customization for each system by healthcare institutions or the government. The inconsistency in data formats requires healthcare institutions and the government to spend more time on data parsing and mapping, resulting in slow integration of medical data. In this study, we simulated healthcare institutions using Fast Healthcare Interoperability Resources (FHIR) for medical information exchange and utilized the exchanged medical information to create a dynamic dashboard to assist healthcare professionals in making medical decisions. To ensure information security, we employed Hyper Text Transfer Protocol Secure (HTTPS) for secure transmission, which encrypts the transmitted medical record data using the Transport Layer Security (TLS) protocol, preventing deliberate interception and tampering of medical record data between the two systems. Finally, to test the load and performance of static and dynamic resources and web applications, we conducted a system performance evaluation using Apache JMeter. The results of this study demonstrate that replacing the gateway of the Electronic Medical Record Exchange Center with an FHIR server effectively reduces the time and cost spent by developers on data format conversion while also mitigating the information security risks associated with the previous VPN solution. Additionally, by utilizing dynamic charts, healthcare professionals are assisted in making medical decisions. [ABSTRACT FROM AUTHOR]

A medical entity (hospital, nursing home, rest home, revalidation center, etc.) usually includes a multitude of information systems that allow for quick decision-making close to the medical sensors. The Internet of Medical Things (IoMT) is an area of IoT that generates a lot of data of different natures (radio, CT scan, medical reports, medical sensor data). However, these systems need to share and exchange medical information in a seamless, timely, and efficient manner with systems that are either within the same entity or other healthcare entities. The lack of inter- and intra-entity interoperability causes major problems in the analysis of patient records and leads to additional financial costs (e.g., redone examinations). To develop a medical data interoperability architecture model that will allow providers and different actors in the medical community to exchange patient summary information with other caregivers and partners to improve the quality of care, the level of data security, and the efficiency of care should take stock of the state of knowledge. This paper discusses the challenges faced by medical entities in sharing and exchanging medical information seamlessly and efficiently. It highlights the need for inter- and intra-entity interoperability to improve the analysis of patient records, reduce financial costs, and enhance the quality of care. The paper reviews existing solutions proposed by various researchers and identifies their limitations. The analysis of the literature has shown that the HL7 FHIR standard is particularly well adapted for exchanging and storing health data, while DICOM, CDA, and JSON can be converted in HL7 FHIR or HL7 FHIR to these formats for interoperability purposes. This approach covers almost all use cases. [ABSTRACT FROM AUTHOR]

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Interoperability of clinical data remains an issue in healthcare despite technology advancements. FHIR, Fast Healthcare Interoperability Resources, is a standard for electronic exchange of healthcare data that is built on web standards, flexible, user-friendly and easy to implement. This research aims to assess FHIR's potential as a solution for interoperability by identifying critical components of FHIR that can improve interoperability and bridge the gap between healthcare systems and sources of clinical data. By leveraging FHIR as a standard, healthcare professionals are able to more effectively communicate and access patient information leading to better patient care and more efficient clinical operations. [ABSTRACT FROM AUTHOR]

Currently, the Taiwan Electronic Medical Record Exchange Center uses the Clinical Document Architecture (CDA) framework, which is based on the international medical standard. The CDA R2 standard, defined in 2005, is used for cross-institution retrieval of electronic medical records (Ministry of Health and Welfare, Information Department, 2021). However, CDA R2 only supports the exchange of clinical documents and is limited to the XML format. Due to the lack of a standardized framework for medical data exchange in Taiwan, different standards and specifications result in different data interface methods between systems, requiring customization for each system by healthcare institutions or the government. The inconsistency in data formats requires healthcare institutions and the government to spend more time on data parsing and mapping, resulting in slow integration of medical data. In this study, we simulated healthcare institutions using Fast Healthcare Interoperability Resources (FHIR) for medical information exchange and utilized the exchanged medical information to create a dynamic dashboard to assist healthcare professionals in making medical decisions. To ensure information security, we employed Hyper Text Transfer Protocol Secure (HTTPS) for secure transmission, which encrypts the transmitted medical record data using the Transport Layer Security (TLS) protocol, preventing deliberate interception and tampering of medical record data between the two systems. Finally, to test the load and performance of static and dynamic resources and web applications, we conducted a system performance evaluation using Apache JMeter. The results of this study demonstrate that replacing the gateway of the Electronic Medical Record Exchange Center with an FHIR server effectively reduces the time and cost spent by developers on data format conversion while also mitigating the information security risks associated with the previous VPN solution. Additionally, by utilizing dynamic charts, healthcare professionals are assisted in making medical decisions.

In order to support innovation, the Society of Imaging Informatics in Medicine (SIIM) elected to create a collaborative computing experience called a "hackathon." The SIIM Hackathon has always consisted of two components, the event itself and the infrastructure and resources provided to the participants. In 2014, SIIM provided a collection of servers to participants during the annual meeting. After initial server setup, it was clear that clinical and imaging "test" data were also needed in order to create useful applications. We outline the goals, thought process, and execution behind the creation and maintenance of the clinical and imaging data used to create DICOM and FHIR Hackathon resources.

Currently in hospitals, there are several separate information systems that manage, very often autonomously, the patient's personal, clinical and diagnostic data. An electronic health record system has been specifically developed for a cardiology ward and it has been designed "ab initio" to be fully integrated into the hospital information system and to exchange data with the regional health information infrastructure. All documents have been given as Health Level 7 (HL7) clinical document architecture and messages are sent as HL7-Version 2 (V2) and/or HL7 Fast Healthcare Interoperability Resources (FHIR). Specific decision support sections for specific aspects have also been included. The system has been used for more than three years with a good level of satisfaction by the users. In the future, the system can be the basis for secondary use for clinical studies, further decision support systems and clinical trials. [ABSTRACT FROM AUTHOR]

Heterogeneity is a problem in storing and exchanging data in a digital health information system (HIS) following semantic and structural integrity. The existing literature shows different methods to overcome this problem. Fast healthcare interoperable resources (FHIR) as a structural standard may explain other information models, (e.g., personal, physiological, and behavioral data from heterogeneous sources, such as activity sensors, questionnaires, and interviews) with semantic vocabularies, (e.g., Systematized Nomenclature of Medicine—Clinical Terms (SNOMED-CT)) to connect personal health data to an electronic health record (EHR). We design and develop an intuitive health coaching (eCoach) smartphone application to prove the concept. We combine HL7 FHIR and SNOMED-CT vocabularies to exchange personal health data in JavaScript object notion (JSON). This study explores and analyzes our attempt to design and implement a structurally and logically compatible tethered personal health record (PHR) that allows bidirectional communication with an EHR. Our eCoach prototype implements most PHR-S FM functions as an interoperability quality standard. Its end-to-end (E2E) data are protected with a TSD (Services for Sensitive Data) security mechanism. We achieve 0% data loss and 0% unreliable performances during data transfer between PHR and EHR. Furthermore, this experimental study shows the effectiveness of FHIR modular resources toward flexible management of data components in the PHR (eCoach) prototype. [ABSTRACT FROM AUTHOR]

The lack of electronic health record data in general and especially at initial phases of medical research projects is common and is one of the main reasons for delay or failure of such projects. One of the health areas with little attention is the home care area, where patients are being supported by their families or informal caregiver at home. In this paper we present related work on medical data formats and synthetical data generation of medical health records. Furthermore, it presents an approach to generate synthetic electronic health records (HER) that are readily available; suited to research; and free of legal, privacy, security and intellectual property restrictions to be used in home care research projects. We adapted and used Synthea™, an open-source software framework that simulates the lifespans of synthetic patients to generate synthetic EHRs. This paper presents the use case of home care from the capturing of user requirements of home care patients, translating the requirements into a data model, feeding the data model into Synthea™ framework, which produces synthetical health data records mainly as QuestionnaireResponse instance of the Fast Healthcare Interoperability Resources (FHIR) to using these EHRs to build an initial machine learning data model for home care. [ABSTRACT FROM AUTHOR]

An infrastructure for the management of semantics is being developed to support the regional health information exchange in Veneto - an Italian region which has about 5 million inhabitants. Terminology plays a key role in the management of the information fluxes of the Veneto region, in which the management of electronic health record is given great attention. An architecture for the management of the semantics of laboratory reports has been set up, adopting standards by HL7. The system has been initially developed according to the common terminology service release 2 (CTS2) standard and, in order to overcome complexities of CTS2 is being revised according to the Fast Healthcare Interoperability Resources (FHIR) standard, which has been subsequently introduced. Aspects of CST2 and of FHIR have been considered in order to retain most suitable aspects of both. This integration can be regarded as most worthwhile. [ABSTRACT FROM AUTHOR]

Currently in hospitals, there are several separate information systems that manage, very often autonomously, the patient’s personal, clinical and diagnostic data. An electronic health record system has been specifically developed for a cardiology ward and it has been designed “ab initio” to be fully integrated into the hospital information system and to exchange data with the regional health information infrastructure. All documents have been given as Health Level 7 (HL7) clinical document architecture and messages are sent as HL7-Version 2 (V2) and/or HL7 Fast Healthcare Interoperability Resources (FHIR). Specific decision support sections for specific aspects have also been included. The system has been used for more than three years with a good level of satisfaction by the users. In the future, the system can be the basis for secondary use for clinical studies, further decision support systems and clinical trials.

Heterogeneity is a problem in storing and exchanging data in a digital health information system (HIS) following semantic and structural integrity. The existing literature shows different methods to overcome this problem. Fast healthcare interoperable resources (FHIR) as a structural standard may explain other information models, (e.g., personal, physiological, and behavioral data from heterogeneous sources, such as activity sensors, questionnaires, and interviews) with semantic vocabularies, (e.g., Systematized Nomenclature of Medicine—Clinical Terms (SNOMED-CT)) to connect personal health data to an electronic health record (EHR). We design and develop an intuitive health coaching (eCoach) smartphone application to prove the concept. We combine HL7 FHIR and SNOMED-CT vocabularies to exchange personal health data in JavaScript object notion (JSON). This study explores and analyzes our attempt to design and implement a structurally and logically compatible tethered personal health record (PHR) that allows bidirectional communication with an EHR. Our eCoach prototype implements most PHR-S FM functions as an interoperability quality standard. Its end-to-end (E2E) data are protected with a TSD (Services for Sensitive Data) security mechanism. We achieve 0% data loss and 0% unreliable performances during data transfer between PHR and EHR. Furthermore, this experimental study shows the effectiveness of FHIR modular resources toward flexible management of data components in the PHR (eCoach) prototype.

As part of the digitalization strategy for medical documentation, we introduced a vendor-neutral archive (VNA) at the Jena University Hospital. The VNA provides data based on interoperable formats for all clinical systems and for communication with other actors as well as for secondary data use. HL7 FHIR is used as a standard for structuring individual data. Using the example of allergy documentation, the paper describes objectives, work status, and experiences from several sub-projects currently being pursued in Jena to establish FHIR. Challenges in information modelling, semantic annotation, connection of clinical sub-systems and integration of FHIR resources in archiving structures and processes are discussed and the necessary cooperation for profiling technical standards is indicated.

After more than 20 years of experience with HL7 v2.x and 15 years with Version 3.0, HL7 International (http://www.hl7.org/) raised the question how the experience and knowledge gained could be migrated to a new, but simpler standard that is also more modern. The result is a new framework called FHIR (Fast Healthcare Interoperability Resources) that is under development and testing for more than 10 years now and will be explained in the following. The interest in FHIR is rising not only worldwide, but also in Germany leading to more FHIR-based specifications as the foundation for open and standardized interfaces. [ABSTRACT FROM AUTHOR]

Twenty-five years of LOINC (Logical Observation Identifier Names and Codes) and almost 20 years of experience with the implementation of LOINC in Germany – without having so far achieved a binding national definition of or a relevant routine use of LOINC in laboratory data communication. This article sketches the development of LOINC use in Germany since the year 2000 on the basis of grey literature. For the first time, the use of LOINC in Germany is experiencing a significant impetus at the national level: On the one hand, the current health legislation with its stipulations for a legally defined electronic patient record provides the necessary framework for nationwide stipulations; on the other hand, there is a significant impulse from the German Medical Informatics Initiative (MII) out of the medical research field for implementing a uniform LOINC subset. In recognition of the 25th anniversary of the LOINC nomenclature (1995–2019), the article traces the emergence of LOINC – which is characterized by interactions between European (EUCLIDES, READ, NPU) and US (HL7, LOINC, SNOMED CT) developments and the interplay of various standardization initiatives. Different national definitions and e-health strategies resulting from this history will be a challenge for the future e-health harmonization in the EU. The concerns of medical research and biobanking must be taken into account here, since the standardization of lab data according to international nomenclatures is of utmost importance for them. [ABSTRACT FROM AUTHOR]

Arden Syntax, a medical knowledge representation and processing language for clinical decision support tasks supervised by Health Level Seven International (HL7), was extended with HL7’s Fast Healthcare Interoperability Resources (FHIR) constructs to allow standardized data access. The new version, Arden Syntax version 3.0, was successfully balloted as part of the audited, consensus-based, iterative HL7 standards development process. [ABSTRACT FROM AUTHOR]

Background: Blockchain and distributed ledger technology is a disruptive force in healthcare. Methods: This article provides a globally relevant, interdisciplinary perspective intended to aid disparate group of actors, participants, and users that represent the diverse stakeholders of an increasingly complex and technologically reliant healthcare system. Domain expertise reinforced by literature published via industry, technical, and academic venues was used to inform these perspectives. Results: Key characteristics of blockchain and distributed ledger technology are highlighted and framed for a readership ranging from healthcare executive to policy makers to researchers. Antecedent application of blockchain in the financial sector is explored followed by the technical, security, and interoperability considerations specific to healthcare. Conclusion: Blockchain remains an emerging technology both fraught with unanticipated challenges and the promise of unrealized potential in healthcare. Keywords: Blockchain, Healthcare, Innovation, Adoption, Global, Interoperability

Building an integrated data model that includes not only clinical data but also personal health records has become increasingly important. We aimed to build a big data healthcare platform by developing a common data model that can be utilized in the healthcare field. To this end, we acquired health data from various communities to establish community care digital healthcare service models. Further, to improve personal health data interoperability, we ensured conformance to international standards, namely, the Systemized Nomenclature of Medicine Clinical Terms (SNOMED-CT) and transmission standards, namely, Health Level 7 Fast Healthcare Interoperability Resource (HL7 FHIR). Furthermore, FHIR resource profiling was designed to transmit and receive data, following the HL7 FHIR R4 guidelines. [ABSTRACT FROM AUTHOR]

According to the German E-Health-Law it will be mandatory to hand out a national medication plan (BMP) in printed form to all patients that have a prescription of three or more drugs to take at the same time starting 1 April, 2017. Part of this printout is a datamatrix code that encodes all medication information using the XML-based UKF (German: Ultrakurzformat) in order to include a means for a standardized electronic transfer of the data. Generated by the general practitioner, the medication plan also needs to be updated through medical specialists, clinical doctors or pharmacists. This paper documents, based on usage scenarios for the BMP, the long way from theory to practical use and points to organizational and technical hurdles that need to be overcome as part of the digitalization. Along with the implications for the process dimension, a technical infrastructure is introduced and different challenges in working with the UKF are identified and discussed

Objectives: Pharmacogenomics (PGx) is often considered a low-hanging fruit for genomics-electronic health record (EHR) integrations, and many have expressed the notion that drug-gene interaction checking might one day become as much a commodity in EHRs as drug-drug and drug-allergy checking. In addition, the U.S. Office of the National Coordinator has recognized the trend toward storing complete sequencing data outside the EHR in a Genomic Archiving and Communication System (GACS) and has emphasized the need for "pilots that test Fast Healthcare Interoperability Resources (FHIR) Genomics for GACS integration with EHRs." We sought to develop a PGx clinical decision support (CDS) service, leveraging the emerging FHIR and CDS Hooks standards, and based on an assumption that pharmacogene sequencing data would be stored alongside the EHR in a GACS.Methods: We developed a PGx CDS service as a functional prototype. The service is triggered by a medication order in the EHR. When evoked, the service looks for relevant genetic data in a GACS and returns corresponding recommendations back to the ordering clinician. Where the patient has no genetic data on file, the service can recommend pretreatment genetic testing where applicable.Results: Overall, we were able to meet our objectives and deploy a functional prototype, interfaced with a commercial EHR. We identified several areas where FHIR or CDS Hooks lacked necessary semantics or have implementation ambiguity. Primary FHIR challenges included multiple ways to say the same thing, which exacerbated the complexity of variant to allele conversion and lack of representation of deoxyribonucleic acid region(s) studied. Primary CDS Hooks challenges included the complexity of executing an authenticated query against one system (GACS) upon being triggered by a different system (the EHR), and limitations in the types of actionable recommendations that can be returned to the EHR.Conclusions: In conclusion, we have found that PGx CDS based on FHIR and CDS Hooks appears to represent a promising means of genomics-EHR integration. More real-world testing along with a set of use-case driven GACS interface requirements will push us closer to the U.S. National Human Genome Research Institute vision of a plug-in PGx app. [ABSTRACT FROM AUTHOR]

Fast Healthcare Interoperability Resources (FHIR) is an open interoperability standard that allows external software to quickly search for and access clinical information from the electronic medical record (EMR) in a method that is developer-friendly, using current internet technology standards. In this article, we highlight the new FHIR standard and illustrate how FHIR can be used to offer the field of radiology a more clinically integrated and patient-centered system, opening the EMR to external radiology software in ways unfeasible with traditional standards. We explain how to construct FHIR queries relevant to medical imaging using the Society for Imaging Informatics in Medicine (SIIM) Hackathon application programming interface (API), provide sample queries for use, and suggest solutions to offer a patient-centered, rather than an image-centered, workflow that remains clinically relevant. [ABSTRACT FROM AUTHOR]

Health Level 7’s (HL7’s) new standard, FHIR (Fast Health Interoperability Resources), is setting healthcare information technology and medical imaging specifically ablaze with excitement. This paper aims to describe the protocol’s advantages in some detail and explore an easy path for those unfamiliar with FHIR to begin learning the standard using free, open-source tools, namely the HL7 application programming interface (HAPI) FHIR server and the SIIM Hackathon Dataset. [ABSTRACT FROM AUTHOR]

Background: The development processes of data exchange standards for use in healthcare are very different from those used in clinical research. Healthcare data standards are traditionally developed by the Health Level 7 (HL7) organization, whereas those for use in clinical research are mostly developed by the Clinical Data Interchange Standards Consortium. No alignment of these standards has so far taken place. Objectives: Due to the increasing use of electronic health records as primary source in clinical research, it becomes necessary to align these standards, not only the semantic standards, but also the data exchange standards (formats) themselves. Methods: Mutual feature gaps between ODM and FHIR are investigated. Results: A transition path how the HL7-FHIR standard and the CDISC-ODM transport standard can grow into a single standard for use both in healthcare and in clinical research is presented. [ABSTRACT FROM AUTHOR]

We sought to enable better interoperability and easy adoption of healthcare applications by developing a standardized domain independent Application Programming Interface (API) for an Electronic Medical Record (EMR) system. We leveraged the modular architecture of the Open Medical Record System (OpenMRS) to build a Fast Healthcare Interoperability Resources (FHIR) based add-on module that could consume FHIR resources and requests made on OpenMRS. The OpenMRS FHIR module supports a subset of FHIR resources that could be used to interact with clinical data persisted in OpenMRS. We demonstrate the ease of connecting healthcare applications using the FHIR API by integrating a third party Substitutable Medical Apps & Reusable Technology (SMART) application with OpenMRS via FHIR. The OpenMRS FHIR module is an optional component of the OpenMRS platform. The FHIR API significantly reduces the effort required to implement OpenMRS by preventing developers from having to learn or work with a domain specific OpenMRS API. We propose an integration pathway where the domain specific legacy OpenMRS API is gradually retired in favor of the new FHIR API, which would be integrated into the core OpenMRS platform. Our efforts indicate that a domain independent API is a reality for any EMR system. These efforts demonstrate the adoption of an emerging FHIR standard that is seen as a replacement for both Health Level 7 (HL7) Version 2 and Version 3. We propose a gradual integration approach where our FHIR API becomes the preferred method for communicating with the OpenMRS platform. [ABSTRACT FROM AUTHOR]

Background: Supporting clinical decision support for personalized medicine will require linking genome and phenome variants to a patient's electronic health record (EHR), at times on a vast scale. Clinico-genomic data standards will be needed to unify how genomic variant data are accessed from different sequencing systems.Methods: A specification for the basis of a clinic-genomic standard, building upon the current Health Level Seven International Fast Healthcare Interoperability Resources (FHIR®) standard, was developed. An FHIR application protocol interface (API) layer was attached to proprietary sequencing platforms and EHRs in order to expose gene variant data for presentation to the end-user. Three representative apps based on the SMART platform were built to test end-to-end feasibility, including integration of genomic and clinical data.Results: Successful design, deployment, and use of the API was demonstrated and adopted by HL7 Clinical Genomics Workgroup. Feasibility was shown through development of three apps by various types of users with background levels and locations.Conclusion: This prototyping work suggests that an entirely data (and web) standards-based approach could prove both effective and efficient for advancing personalized medicine. [ABSTRACT FROM AUTHOR]

The use of advances in technology resources for communication and information has been strongly applied in different economic and social sectors. The health sector was also one of contemplated. The information before stored only on paper, are now available in digital form. This format impacted positively to the dissemination and sharing of such data in order to computerize the health management process, especially among the world organizations such as the WHO. For this interaction was held, the need for standardization in communication of health data between interoperable systems. And because of this, some standards / protocols have been created and adopted to different health sectors. However, noting that health information could be exposed, adulterated and corrupted, was highlighted the importance of security in communication and data sharing between health systems. Not to worry could cause irreversible damage to end users of the system because it is relevant information, mainly from patients. As a result of this concern, several security technologies have emerged. This article will present some of the protocols used worldwide to exchange information and key digital security technologies, their use and importance for interoperable health systems. [ABSTRACT FROM AUTHOR]

Messaging standards, and specifically HL7 v2, are heavily used for the communication and interoperability of Health Information Systems. HL7 FHIR was created as an evolution of the messaging standards to achieve semantic interoperability. FHIR is somehow similar to other approaches like the dual model methodology as both are based on the precise modeling of clinical information. In this paper, we demonstrate how we can apply the dual model methodology to standards like FHIR. We show the usefulness of this approach for data transformation between FHIR and other specifications such as HL7 CDA, EN ISO 13606, and openEHR. We also discuss the advantages and disadvantages of defining archetypes over FHIR, and the consequences and outcomes of this approach. Finally, we exemplify this approach by creating a testing data server that supports both FHIR resources and archetypes. [ABSTRACT FROM AUTHOR]