FHIR: The Future of Healthcare Interoperability

FHIR: The Future of Healthcare Interoperability

By: Kevin Narine and Christopher Sanfilippo, Forum Systems

HL7 FHIR—Fast Healthcare Interoperability Resources—is the future of healthcare interoperability. But what is it? And how does it benefit organizations within the healthcare ecosystem? 

First, FHIR is a data standard (or data model). It was developed by HL7 International to solve known defects of previous standards, especially interoperability. At its core, it specifies how healthcare data is stored, organized, and linked so its meaning is clear to computers and humans. In this sense, it is an alternative to other standards such as HL7 v2 and v3, CDA/C-CDA, and EDI X12. 

FHIR also refers to a standard way of sending and receiving healthcare data through REST APIs. A REST architecture is advantageous because—as opposed to EDI which is document-based—FHIR is resource-based, which allows for simple and flexible queries in a request-response format. FHIR servers, which send and receive JSON and XML payloads, are accessible to essentially any organization.

FHIR defines about 150 healthcare resources. A resource—a term borrowed from HTTP—is just a way to represent information of interest. The image is an example of the FHIR resource that defines a patient. Each resource is tagged in much the same way every page of an ordinary website is tagged. 

FHIR was designed specifically for healthcare and has been enthusiastically received by the healthcare industry. Release 4 (R4), published in late 2019, is the first normative version of FHIR and it is the version that is required by CMS

Resources define the core of the FHIR standard

The Benefits of FHIR

In addition to being a standard way of modeling and sending healthcare data, FHIR was chosen by CMS for its distinct advantages over other standards:

  • It is open-source and free to use.
  • It was designed to be implemented quickly and uses common technologies such as HTTP, REST, JSON, and OAuth.
  • It can easily be extended for particular use cases with Profiles and Extensions
  • It has a massive community of contributors

FHIR and EDI X12

Some terminology is confusing, so let us summarize: the architecture is REST, the protocol is HTTP, and the specification is FHIR. (Security can be handled in different ways, but HL7 recommends using SMART on FHIR which is based on OAuth 2.0.)  

Summarizing in this way also helps to avoid a common confusion about the difference between EDI X12 and FHIR. Both standards attempt to solve the same problem: how can machines and humans exchange healthcare data in a standardized way? 

Though normally sent using the AS2 protocol, it is possible to send EDI X12 documents using HTTP. However in doing so, one is not taking advantage of the benefits of FHIR—as FHIR is a completely separate data standard and API specification. 

Whichever protocol you request EDI X12 documents over, you’re still receiving the digital equivalent of a file cabinet. And you are still processing in batches, with little or no real-time capabilities. With FHIR, you get a snippet of JSON with only the specific information that is required—and intelligent systems can extract meaningful real-time insights. 


Your healthcare organization, if it is not already able, will need to be able to process FHIR transactions. It is unparalleled in its industry and regulatory support. The question is no longer which standard will win out, but rather how fast can every organization—every payer, provider, HIE, MSO, CAPS—start using FHIR for the bulk of their communication?

As interoperability becomes more central to healthcare, FHIR’s streamlined standard makes sending and receiving healthcare resources as simple as possible

Forum Systems encourages all organizations within the healthcare ecosystem to:

  1. Identify and assess your current API capabilities and internal knowledge of FHIR and related technologies
  2. If necessary, educate your teams on FHIR and ensure there is cross-communication between teams dealing with FHIR and those dealing with EDI X12.
  3. Engage healthcare experts, such as Forum Systems, to help you prepare your infrastructure for the new age of healthcare interoperability. 
About Forum Systems

Forum Systems is a leader in intelligent API gateway technology, deep data analytics, and cloud technologies. Forum technology, used by some of the largest global companies for building intelligent business workflows, is certified and secure. Along with industry-leading performance, interoperability, and security, Forum Systems takes pride in their customer-driven innovation and simplified user experience.