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HL7 Releases FHIR Version 4.0 for Healthcare Interoperability

HL7 FHIR R4 contains the first normative content for the interoperability standard, creating a firm foundation for the healthcare IT industry.

HL7 FHIR R4 and healthcare interoperability

Source: Thinkstock

By Jennifer Bresnick

- HL7 International has published the long-anticipated FHIR Release 4 (R4), allowing healthcare organizations to make new leaps forward in health data interoperability.

“R4 is the culmination of 18 months of extensive work to finalize the base parts of the specification, and incorporate changes and enhancement requests received from implementation partners across the world,” HL7 said in a blog post announcing the release.

“FHIR Release 4 marks a significant milestone with the introduction of a normative base. This new maturity will help support our very active and growing community.”

HL7 International CEO Dr. Charles Jaffe told that the release is both a “beginning” and a “legacy” of much hard work.

“HL7 FHIR R4 is a beginning,” he said. “It is the legacy of eight years of innovation and collaboration among a community of thousands around the world.” 

READ MORE: FHIR Testing Tools Can Foster Interoperability, Health Data Exchange

“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.”

FHIR R4 offers the first normative content for the data standard, and includes nearly 3000 changes from the previous version of the interoperability resources.

Normative content has passed through all six stages of the FHIR maturity model, as devised by HL7, indicating that the artifact has undergone extensive review and testing in real-world environments, and is now “locked down” in terms of development.

Creating and publishing normative content is critical for allowing health IT developers to implement FHIR consistently and uniformly, HL7 Chief Technology Officer Wayne Kubick said in October of 2018.

While all of the top 10 health IT vendors covering most of the US market, including Epic and Cerner, have adopted FHIR in some capacity to support consumer-facing application programming interfaces (APIs), most are using Release 2, he explained.  Developers using earlier versions of the standard often differ in their implementation decisions, creating variation in the real-world deployment of the FHIR standard.

READ MORE: FHIR Takes Off as ONC Teases Upcoming Data Blocking Definitions

“[R4] will be a very important accomplishment,” Kubick said during an HL7 Applications Roundtable event held in Washington, DC. “Release 4 will have normative content and metrics that will help it become a stable baseline to allow everyone to catch up.” 

A firm foundation for FHIR-based interoperability will be extremely important for the industry as stakeholders anxiously await the unveiling of the ONC’s data blocking guidelines, currently wending their way through governmental review.

Strengthening the standardization of FHIR will also be critical for developers relying on the data standard to meet their obligations as 2015 Edition Certified EHR Technology (CEHRT) vendors.

The requirement to offer a consumer-facing API came into effect on January 1, 2019 – and continuing to use Release 2, as most vendors are doing, will not be sufficient in the long term. 

“We need to make sure that developers are employing those consistently as FHIR starts really moving into the market,” said Steven Posnack, MS, MHS, Director of the Office of Standards and Technology at the Office of the National Coordinator.

READ MORE: Da Vinci Project Brings HL7 FHIR to Payers for Big Data Analytics

“Consistent use and deployment of the specification in the real world will be key to creating an overall positive experience with FHIR.”

R4 is the latest step towards a seamlessly interoperable data exchange environment, and one that is likely to set the industry up for a successful and productive 2019, added Micky Tripathi, President and CEO of the Massachusetts eHealth Collaborative (MAeHC) and a leader of the Argonaut Project, a private sector initiative heavily involved in developing FHIR.

“2019 is going to be the year where we start to see the real unveiling of FHIR,” he predicted in October.  “The 2015 Edition CEHRT requirement will be a major catalyst for adoption, and R4 is going to be released at a really critical juncture for enabling some of the capabilities we’ve been lacking in healthcare so far.”

“I’m confident that we’re going to see rapid uptake of FHIR in the next year or so, and it’s going to be very exciting to see all of the things that people can start doing now that they have a stable, meaningful language to share.”

The release of R4 is just the beginning of what FHIR can become for an industry struggling to communicate across disparate systems and competing business incentives, added Tripathi.

The Argonaut Project, as well as the payer-centered Da Vinci Project, has plans to use FHIR to enable bulk data sharing, standardized data collection, and the creation of richer information packets to support population health management and broader analytics, he said.

R4 will be an important stepping stone for the industry as it strengthens its commitment to FHIR and the health data interoperability it can support, said Kubick.

“The fundamental infrastructure is in place.  The data is starting to flow,” he said.  “We’ve seen a lot of positive developments over the past few months, and it’s all very exciting.  But I can promise you – this is all just the tip of the iceberg.”


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