I have written a couple of blogs previously to introduce FHIR, including 5 Things to Know About HL7 FHIR and Review of the HL7 FHIR Session at HIMSS13. This standard is evolving steadily within the HL7HL7 is a Standards Developing Organization accredited by the American National Standards Institute (... More organization. The first Draft Standard for Trial Use was available in 2014, and the first normative edition is planned for 2017.

HL7 FHIRFHIR stands for Fast Healthcare Interoperable Resource. This emerging standard combines the best fea... More plans to support four interoperabilityInteroperability refers to the ability of two or more systems or components to exchange information ... More paradigms, which are distinct ways of utilizing FHIRAn HL7 standard that is short for Fast Healthcare Interoperability Resources and pronounced “Fire... More to best accommodate varying workflows. The four paradigms and when they might be used are:

  • restREST (Representational State Transfer) is a web services approach used heavily in social media sites... More – small, light-weight exchanges with low coupling between systems

  • messages – communicate multiple resources in a single exchange

  • documents – focus is on persistence when data spans multiple resources

  • services – use a custom service when capabilities of other paradigms don’t fit requirement

regardless of the paradigm, the content is still based on resources. the resources are just bundled into different data sets depending on the paradigm. below, i outline some of the key differences among the paradigms.

paradigms defined

rest

  • simple, out-of-the-box interoperabilityInteroperability refers to the ability of two or more systems or components to exchange information ... More
  • leverage httpHTTP (Hypertext Transfer Protocol) is the foundation for application-level communication on the inte... More: get, post, etc.
  • pre-defined operations
  • create, read, update, delete
  • works best in environments where control resides on client side and trust relationship exists

messages

  • similar to hl7HL7 is a Standards Developing Organization accredited by the American National Standards Institute (... More v2 and v3 messaging
  • a bundle of resources
  • allows request/response behavior 
  • event-driven (e.g., send lab order, get back result)
  • can be asynchronous

documents

  • similar to cdaClinical Document Architecture (CDA) HL7 CDA uses XML for encoding of the documents and breaks down ... More
  • a bundle of resources
  • root is a “composition” resource that acts like a cda header
  • one context
  • can be signed, authenticated, etc.

services

  • custom resource packaging and intelligence/individual resources or bundles 
  • ultra-complex or ultra-simple workflows
  • use httpHTTP (Hypertext Transfer Protocol) is the foundation for application-level communication on the inte... More or other protocols
  • only constraint is that fhirAn HL7 standard that is short for Fast Healthcare Interoperability Resources and pronounced “Fire... More resources are passed from one system to another

one key element to point out is that regardless of the paradigm, the content is the same. this means that it is straightforward to share content across these paradigms.

for example, an application might receive a lab result message and turn around and package it in a summary of care document. in addition, constraints can be shared across paradigms. for example, a profile can be established for blood pressure and used in all of the domains discussed above.

fhirAn HL7 standard that is short for Fast Healthcare Interoperability Resources and pronounced “Fire... More is meant to be flexible to use and easy to implement. fhirAn HL7 standard that is short for Fast Healthcare Interoperability Resources and pronounced “Fire... More does not care about the architectural design of the systems. it works equally well for light (mobile) clients and heavy (infrastructure) clients. it can be used for push-based requirements or query-based requirements.

fhirAn HL7 standard that is short for Fast Healthcare Interoperability Resources and pronounced “Fire... More is promising in many different ways and it will be interesting to watch as it develops and more folks voice their praises and concerns.

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