Edifecs - Pathways to Healthcare Partnerships

Leveraging FHIR To Improve Interoperability

Leveraging FHIR To Improve Interoperability

FHIR is a newly developing standard from HL7, which encapsulates all the latest industry standard best practices along with the most modern and proven technologies to derive maximum ROI through healthcare information interoperability. Here we explains why major US Health Plans are starting to adopt FHIR.

Fast Healthcare Interoperability Resources (FHIR) is a standard for clinical data, developed by HL7 with the tight collaboration with the Healthcare community, including major US Provider organizations, Vendors (EMR, HIPAA gateway software, etc.), Payers (Blue Plans, commercial payers, government sector). By nature, FHIR defines the group of Along with the Resources, there are very well defined ways of communication and information retrieval as well as the cross-referencing of the information.

More information on FHIR, including comprehensive examples, client API on C# and Java is available at HL7 FHIR Documentation website.

These days healthcare Insurers deal very well with the financial information provided to them in the electronic form. The industry is evolving from pay for service to pay for value with the overall incentive on improving healthcare and reducing the operational costs. Health plans are looking to collect clinical information from providers in order to provide better Care Management, Risk Assessments, Care Alerts to PCP, Prior Authorization, Fraud & Abuse and many others.

There are various ways of accepting the clinical data – SFTP, Web Services, VANs / VPNs, MLLP over SSL and many other legacy channels. HL7 declared a new, simple and modern way for clinical interoperability through the FHIR. FHIR relies on a REST Web Services delivery channel, assuming highest security models and flexible storage implementation – any DB or storage can be used (relational databases, NoSQL, simple storages, etc.).

Typical Health Plan has the following major components for handling the clinical data:

  • Communication Channel – SFTP, VAN/VPN, MLLP, Other
  • Security Layer – VPN, SSH, SSL, Other
  • Persistent Storage – MS SQL Server, Oracle – those are most typical
  • Business Model and Physical DB Layer
  • Back-End Core Clinical Application consuming the data

FHIR allows the plan to handle almost all of these components in a standardized fashion. The table below, shows the match between the typical components and FHIR capabilities:

Traditional Payer Component FHIR Capability Comments
Communication REST API over SSL with Server Security FHIR allows for flexibly security managements and does not enforce any particular web server
Security Server level security and SSL for transport security
Persistence Requirements on the server to support certain REST API, but any persistent storage is applicable Unlike the home-grown or even commercial solutions, FHIR does not impose any strict requirements on how the data is stored as long as the access is provided in a required fashion
Business Model FHIR Resources List of resources allow to describe any clinical case or event along with numerous examples and various resource linkage combinations


On January 17, Edifecs participated in the FHIR Connectathon in San Antonio, TX to showcase the typical use-case of Provider- Payer-PCP interoperability for  Clinical Alert.

The use case showed an example of the FHIR Server hosted by the Health Plan and two Provider institutions, connected to it:

  • The situation used in the demo was of a patient getting admitted into the Emergency Room with an illness that could have been caused by improper admission of medication.
  • EMR system of the ER Hospital sends the FHIR message to the FHIR Server on the Health Plan following the admit HL7 message, communicating the Patient resource.
  • Clinical Alert system on the side of the Health Plan immediately picks up the message and communicates it to PCP to notify him about the fact his patient was admitted into ER.
  • PCP receives the information about this clinical case in FHIR format and imports to its EMR system.
  • Follow-up call and appointment is scheduled for the patient to resolve the issue with the medication admission.

This example shows how patient care can be significantly improved by the use of modern technologies, including FHIR. Along with care modernization, there are cost savings for the health plan by avoiding further expensive treatment of the patient, which would have occurred if PCP did not schedule a follow-up appointment and possible preventive treatment.

This demo was possible because of the FHIR Client capabilities of Edifecs XEngine Server, which is the software that most of the US Health Plans are using in their front-end HIPAA systems. Edifecs continues to actively work with the FHIR community on enhancing and facilitating the FHIR integration for payers and providers and we encourage any questions or feedback

Maxim Abramsky is a Director of Product Management at Edifecs with over 10 years of experience in Healthcare Information Systems and related business technologies. Primary focus is on verticalizing product offerings for the US Healthcare Industry with direct expertise in working with large BCBS plans, Commercial and Delta Dental plans, State Medicaid plans and with national Center for Medicare Services.