HL7 publishes normative version of FHIR standard

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Health Level 7 International has published Release 4 of its Fast Healthcare Interoperability Resources, marking a major milestone for the emerging standard, which is based on modern internet conventions.

According to HL7, the most significant advancement with FHIR Release 4 (R4) is that the base platform of the standard has passed a normative ballot and will be submitted to the American National Standards Institute.

“Some of the resources are normative, meaning that backward compatibility is assured for those,” says Chuck Jaffe, MD, HL7’s CEO, who contends that applications that implement the normative parts of R4 no longer risk being non-conformant to the standard.

“This is critical, because it assures stability of the standard for both the community of developers and, perhaps more importantly, the implementers,” adds Jaffe.

App developers, health IT vendors and providers have widely embraced FHIR—which includes the RESTful application programming interface—to help solve the interoperability challenges confronting the healthcare industry as it seeks to increase access to electronic health records and data sharing.

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Josh Mandel, MD, chief architect for Microsoft Healthcare and a strong supporter of FHIR, sees R4 as a “tremendous milestone” for the healthcare interoperability standards community.

“R4 is the first release of the FHIR specification to include normative content, meaning that for 11 resources labeled as ‘normative,’ we’re committed to maintaining forward compatibility with future versions of FHIR,” says Mandel. “These new resources include core clinical definitions like Patient and Observation, as well as some of the internal data structures used for defining conformance requirements (for example, StructureDefinition).”

Specifically, the following portions of FHIR R4 are now considered normative:

• The RESTful API, the XML and JSON formats and the basic datatypes

• The Terminology Layer (CodeSystem and ValueSet)

• The Conformance Framework (StructureDefinition and CapabilityStatement)

• The key resources Patient and Observation

In addition to a set of normative resources, Mandel notes that FHIR R4 includes a wide array of updates and improvements based on collective implementation experience over the past two years.

“For example, the resources needed to support the Meaningful Use Common Clinical Data Set/US Core Data for Interoperability have continued to progress through the FHIR Maturity Model,” he adds. “I expect we’ll see broadening adoption of these resources as more organizations enable FHIR-based access.”

The standard will to continue to evolve “as it responds to the interoperability needs of the robust FHIR implementation community,” states HL7’s announcement. Going forward, HL7 says its priority for the next release is to “bring more sections of the standard to normative status and continue to respond to the needs of the community that is building solutions.”

For its part, the Argonaut Project is a collaboration HIT vendors and providers designed to accelerate the adoption of FHIR by creating “road-tested” implementation guides accessible to developers to build interoperability capabilities.

“HL7 FHIR R4 is a beginning,” adds Jaffe. “It is the legacy of eight years of innovation and collaboration among a community of thousands around the world. It is a commitment from HL7 to create a platform from which Interoperability can someday emerge. It is a promise to provide reusable data across the continuum of biomedical research, patient care, and population health.”

"Overall, FHIR's continued maturity is a great sign," says Steve Posnack, executive director of ONC’s office of technology. "This first batch of 'normative' components will provide a new level of stability for the standard and its implementers. The hard work continues though. Through our cooperative agreement with HL7, ONC will support updates to the older FHIR profiles and implementation guides the industry needs to put this release into production. We look forward to seeing innovative uses of FHIR R4."

A complete list of resources included in FHIR R4 can be found here.

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