HL7: theory and practice of using the standard

Currently, many healthcare institutions are preparing for the practical operation of electronic health records. Many of these systems use proprietary data formats or coding systems, and there is little interoperability between different systems. This is due to the lack of a standard description format for the exchange of electronic health information. To solve this problem, the Ministry of Health, Labour and Welfare’s “Big Health and Medical Informatization Project” “Standardization of Terminology, Codes, and Formats for the Exchange of Electronic Information” have defined “HL7 version 2 4 or later and version 3. 0 (XML format)”. 

HL7 is a US ANSI standard that is in the process of being adopted by ISO and is the most widely used health information exchange protocol in countries around the world. Langate company provides hl7 interoperability service to define the data format (messages) required for information exchange in domestic electronic healthcare systems.

The purpose of this paper is to define a standard format for the exchange of medical information in HL7, create a database, publish a repository and distribute standard HL7 messages so that electronic health record systems of different manufacturers can exchange medical information. Interoperability enables secure and reliable exchange and sharing.

Overview of HL7 FHIR 

• Service can be launched in a short period of time.
• (The core of digital health policy in the U.S. and other countries is the promotion of interoperability. The next-generation measures system for well-being data trade was made by HL7 Worldwide. Based on an arrangement of HL7 International standards, HL7 form 2, HL7 adaptation 3, and the great highlights of CDA (Clinical Document Architecture), it was created with an accentuation on executing capacity by utilizing the most recent Web advances. The standard was created based on HL7 adaptation 2, HL7 adaptation 3, and CDA (Clinical Document Architecture).
• It is planned to empower the trade of healthcare-related data, counting not as it were restorative records and other information, but to information related to healthcare-related regulatory errands, information relating to open well-being, and inquiries about information. It covers both human medicine and veterinary pharmaceuticals and is expected to utilize around the world in a wide assortment of settings, counting inpatient, outpatient, intense care, gaining strength, and community pharmaceutical.

HL7 FHIR Features

Easy to implement:

• Concise and easy-to-understand specifications, human-readable data in an implementor-friendly format, fast and easy to implement, and currently available for free from HL7 International. 
• RESTful architecture, consistent data trade utilizing messages or records and bolster for a service-based engineering XML, JSON, HTTP, OAuth, etc. embraced or prescribed.
• Basic resources can be used without modification. It can be custom fitted to meet nearby prerequisites utilizing profiles, expansions, glossaries, etc.

Active implementer community:

• Numerous usage libraries and illustrations are accessible for prompt advancement. In expansion to the expansion details, different archives, improvement systems, usage libraries, etc. are accessible to back implementers.
• As it were, vital information can be extricated and utilized from put away information in existing designs: Mapping and usage procedures are displayed so that the benchmarks can be created developmental from HL7 adaptation 2.x and CDA, and can coexist with more seasoned measures, and can be utilized commonly. (In any case, there are issues to be tended to in personal cases.)

Overview of HL7 FHIR Specification

FHIR defines “small logically independent units of data exchange” called “resources” and APIs as major components in the basic specification.

FHIR provides a basic frame, including specific methods necessary for implementation, and is easy to implement.

Resources:

• All exchangeable content is defined as a resource.
• Representing an abstract concept of something in healthcare Resources: All exchangeable content is defined as a resource, which represents an abstract concept of something in healthcare (e.g., entities involved (patient, physician, care team, device, etc.), information to be recorded and managed (clinical information, diagnostic information, drugs), etc.).
• Behavior and meaning are defined.
• Uniquely identifiable by Uniform Resource Identifier (URI) – Defined by common web technologies such as XML and JSON (JavaScript Object Notation) – FHIR basic specifications were established with a policy of 80% as the standard and 20% extension for diversity in the field (80% rule).
• Actively refer to and reuse other common specifications, glossaries, etc.
• API (Application Programming Interface):
• Accept processing requests related to information linkage between medical information systems and other systems – Position REST (REpresentational State Transfer) API as the core technology (acquire, update, generate, delete, and access resource metadata). REST (REpresentational State Transfer) API is positioned as the core technology (that allows the acquisition, update, generation, and deletion of resources, acquisition of resource metadata, and acquisition of methods (behaviors) supported by resources).

International Experience

1. The U.S. Department of Health and Human Services’ Office of National Healthcare IT Coordination (ONC) is considered to have contributed to the dissemination and modernization of the healthcare IT field by empowering the interest of EHR improvement sellers, etc. and usage of open APIs through motivating force measures within the open healthcare protections framework and substantial punishment measures within the shape of diminished stipend. NHS Digital, the UK’s National Health, and Social Care Information Centre, included APIs that are based on inter-GP collaboration in the certification criteria of its procurement plan, thereby forcing vendors to develop APIs based on the standards, which is considered to have contributed to the diffusion of the standard. This is thought to have contributed to the spread.

2. Within the Netherlands, the sanctioning of the Client Rights Assurance Act (2016), a law that advances the utilization of healthcare information (PHR) from the viewpoint of anticipation, which moreover covers healthy people, activated the got to the construction of the PHR foundation. While EHRs targeting patients had already been built on HL7 v3, FHIR is believed to have been adopted for ease of implementation and to encourage participation, given that it is a new infrastructure. In other countries, the healthcare systems and insurance systems differ, as do the objectives of building an infrastructure for sharing medical information, but it can be said that the construction of networks is proceeding sequentially.

Organizing from the Perspective of Promoting Dissemination in Other Countries

In the U.S. and the U.K., FHIR-based APIs are used in government-run information systems, and implementation guides and sandboxes have been established and deployed, contributing to the promotion of HL7 FHIR dissemination. Referring to cases in the U.S. and the Netherlands, it was found that implementation guides, sandboxes*, etc. have been established and deployed through public-private partnership initiatives, contributing to the promotion of HL7 FHIR diffusion.