Dive Brief:

• Health Level Seven International released a new version of its Fast Health Interoperability Resources (FHIR) standard, an interoperability framework aimed at improving data sharing between providers and patients.
• FHIR Release 4 will be submitted to ANSI as a normative standard, meaning future revisions will be backward compatible.
• The new version includes a RESTful API, which is one of the parts of the standard that is now normative. The feature relies on HTTP protocol to get, put, post and delete data.

Dive Insight:

FHIR use is growing, with providers increasingly relying on it to boost connectivity and ease the exchange of health information. As providers update their IT to 2015 edition criteria, which includes open APIs, developers are incorporating FHIR into their products.

According to a recent ONC report, nearly a third of health IT developers preparing to meet 2015 Edition EHR certification requirements are currently using FHIR Release 2. More than half are using FHIR combined with OAuth 2.0, the industry standard for authorization. 

The numbers are significant because about 82% of hospitals and nearly two-thirds of clinicians use 10 vendors that offer FHIR version EHRs. CMS has set a 2019 deadline for providers to comply with 2015 certification, and CMS Administrator Seema Verma has actively promoted use of open APIs to increase data sharing and discourage information blocking.

Overall, 87% of hospitals and 69% of Merit-Based Payment Incentive System-eligible clinicians use health IT developers that certify their products to some FHIR version.

In August, Geisinger and pharma giant Merck rolled out a set of patient communication and care delivery apps that comply with FHIR and two other open-source formats. Microsoft is also touting the framework with its FHIR Server for Azure, an open source project on GitHub meant to facilitate sharing and management of health data in the cloud.

Grahame Grieve, HL7 FHIR product director, called the R4 version a "significant milestone" in FHIR's maturity and stability as an interoperability tool.

In addition to RESTful API, other normative features include XML and JSON formats and basic data types, the terminology layer (CodeSystem and ValueSet), the conformance framework (StructureDefinition and CapabilityStatement) and key resources Patient and Observation.