Designing Interoperable Health Care Services Based on Fast Healthcare Interoperability Resources: Literature Review (Preprint)

Abstract

BACKGROUND In the era of the digital economy, the demand for medical and public health services has soared in recent years, asking for developing innovative healthcare service models. This trend has accelerated the urgency to implement effective and efficient data exchange and service interoperability, which enable coordinated care services among tiered healthcare institutions, improve the quality of oversight of regulators, and provide vast and comprehensive data collection to support clinical medicine and health economics research, thus improving the overall service quality and patient satisfaction. However, the isolated data islands among heterogeneous IT systems have been a significant problem, seriously restricting data sharing and service interoperability capabilities. In this context, HL7 FHIR was formally introduced in 2014 and has since continued evolving. Because of its many advantages, such as a simple data model, flexible exchanging model, and adequate open source tools, this standard has attracted worldwide attention in the healthcare industry and has been adopted and promoted by health systems in the UK, USA, and Canada. OBJECTIVE By investigating and analyzing the latest literature on FHIR from the perspectives of motivations, techniques, and applications, we proposed a general FHIR Practice Guideline (FHIR PG) to facilitate stakeholders in the healthcare ecosystem to both understand the FHIR standard and build interoperable services with ease. METHODS We identified 487 papers from the Web of Science and IEEE databases and selected 85 papers published between January 1, 2020, and July 1, 2022, as the source of investigation. First, we chose to classify these papers into three categories: data standardization, data management, and data interoperation, for each of which we discussed the motivations, techniques, and applications. Then, we proposed a general FHIR PG for the entire FHIR practice process through careful analysis and collation. RESULTS The general FHIR PG clarified the unique roles of all the stakeholders involved, including the Implementation Guides (IGs) standard committee, healthcare IT system vendor, and application developer. And it integrated the data standardization flow, data exchange model, and service implementation approach into a complete practice process. As a result, the general FHIR PG facilitates stakeholders to practice the FHIR standard and design interoperable healthcare services. CONCLUSIONS This paper proposed a general FHIR PG by discussing the process of data standardization, data management, and data interoperation from the latest literature. The general FHIR PG can help a stakeholder in the healthcare ecosystem to identify its unique roles, manage the scope of responsibilities, and plan the work content, thereby facilitating the implementation and promotion of the FHIR standard.