26 May, 2022 | 3 min read

FHIR and Interoperability in Digital Health Care - Part 1

  • Mifan Careem
  • Vice President - Global Head of Solution Architecture - WSO2

Photo by Irwan iwe on Unsplash

First published on The New Stack.

From aggregated health data apps to telemedicine and digital front doors, the pandemic has propelled consumer demand for innovative and enhanced health care solutions. McKinsey estimates that global digital health revenues will rise from $350 billion in 2019 to $600 billion in 2024.

Within this context, digital health care interoperability has now become a digital supply chain challenge as health care providers must get data or information out of systems of record, such as electronic health record (EHR) systems, into destination systems and consumers across multiple organizational boundaries while ensuring security and data privacy. This post will look at ways to modernize the digital health care supply chain and outline its challenges and opportunities.

Modernizing Health Care

The pandemic taught us that innovation is key in health care. Organizations with unique digital experiences thrived in the environment, while those who struggled to adapt suffered. Consumer expectations have also soared in the past few years, with patients and members expecting a frictionless digital experience from their health care organizations and access to their data across the health care ecosystem. Interoperability, which is the ability to share the right data across stakeholders, is the most important building block of this movement.

Consider an example organizational scenario where we have a provider, with physicians and patients as part of the provider network, using a single EHR. There might be challenges because providers may have to pull information, which is in a different format such as Health Level 7 Version 2 (HL7 V2) or the American National Standards Institute Accredited Standards Committee electronic data interchange standard (X12), and convert it to a standardized format such as Fast Healthcare Interoperability Resources (FHIR).

According to a study by HIMSS analytics in 2017/2018, an average hospital has 16 disparate EMR vendors. Even a smaller health care provider can have more than one system of record — multiple flavors of an EHR system, some focusing on outpatient systems, a few on inpatient electronic medical records (EMR), and others on ambulatory EMR, a medical billing system, telemedicine software, appointment scheduling systems, etc.

A hospital network must also work closely with payer organizations, which, in turn, need access to their own revenue cycle management (RCM) system and/or claims management system.

What all of this means is that health care organizations, providers, payers, and other health care stakeholders need to deal with many heterogeneous data sources. The emphasis is not only on securely exposing the right data to verified parties, but also aggregating, consolidating, and using the information in a meaningful way.

API-Driven Health Care Integration

Dealing with these multiple challenges is where a health care integration platform comes in. The goal is to connect to these systems, fetch data out of them via connectors, convert the data to an appropriate format or canonical model, aggregate and consolidate it, and either store it or pass it along.

Wearable devices and data shared through them is an important data set to be considered. Once the data is available in the required format, making the information available to stakeholders — which can be third-party organizations, internal or external developers, and other apps or systems — as APIs or other shareable and machine-readable formats in a secure manner is also key.

Fallacies of Systems of Record Handling Integration

There are many supporters of the premise that their EHR would handle connectivity between different systems and provide consolidated information in the required format. While this may be true for specific smaller edge cases or in scenarios where a single vendor provides all the backend systems, in reality, this is far from ideal.

To truly innovate, a health care organization needs access to consolidated information across multiple systems. And the most optimal solution of retrieving such data is to rely on an integration layer that sits independently above the systems of record, which can connect to and transform data from current and future systems and make it available to consumers.

As shown in Figure 1, the provider is connected to multiple electronic health record (EHR) systems, and/or other systems of record, through an integration platform deployed on the provider side.

The platform can then selectively make data available as APIs, and preferably FHIR-based standard APIs, to internal consumers (systems and users) and external consumers such as payer organizations and third-party developers.

Figure 1: An API integration platform enables the provider to connect to multiple EHRs

Data in the Hands of Patients

Interoperability via integration platforms and API standards such as FHIR hold massive potential for the future of digital health care innovation. However, security, privacy and the ownership of data cannot be an afterthought. The Centers for Medicare and Medicaid (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) regulations in the United States place the power of data in the hands of patients. They now need access via the application to their own information, regardless of where the data is stored or who the custodian is.

Moreover, a patient can belong to multiple provider networks, but the information should traverse these networks and be consolidated into a single application across the board. This is an interesting problem because data must now cross organizational boundaries, and the optimal way of doing that is via APIs. To do this, you need a solution that does consent management right.

In our next article, we will elaborate on how APIs can be used to accelerate digital transformation initiatives and point out common issues pertaining to security and how to overcome them.

We hope this post helps readers to understand more about FHIR and interoperability in health care. In the meantime, we encourage you to learn more by visiting WSO2’s solution for open health care at