MyLinks on FHIR

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HL7 FHIR® is one of the many technologies that makes MyLinks possible. Learn more about FHIR and MyLinks.
The healthcare industry is facing an increasing need for interoperability, which refers to the ability of different systems and devices to share and exchange data seamlessly. The lack of interoperability among electronic health record (EHR) systems has been a significant barrier to achieving a fully integrated healthcare system.

However, the introduction of FHIR (Fast Healthcare Interoperability Resources, pronounced "fire") has the potential to revolutionize healthcare interoperability. FHIR has not only improved the exchange of data among EHRs, but it has provided the ability for patients to gather their electronic records from EHR systems.

Background

FHIR is a standard for exchanging healthcare information electronically, based on the same principles as the web. It uses similar technology, making it easy to integrate with existing systems. The FHIR standard is developed and maintained by HL7 (Health Level Seven International), a non-profit organization that creates and maintains standards for the exchange of clinical and administrative data.

FHIR was designed to be modern, flexible, and easy to implement, with a focus on using widely-accepted web standards such as RESTful web services and JSON (JavaScript Object Notation). It builds on previous standards developed by HL7, such as HL7 v2 and HL7 v3, but is intended to be simpler and more flexible than those standards.

FHIR was first published in 2011, and has since undergone several revisions, with the latest version being FHIR R4. It has been widely adopted and is supported by major EHR vendors, government agencies, research organizations, and other healthcare organizations worldwide. It's also being used by many health-related industries like medical devices, wearables and health apps. As of December 31, 2022, all certified EHRs are required to provide patients access to their data via consumer applications that use the FHIR standard (more about the government mandates below).

What are the Benefits of FHIR?

One of the main benefits of FHIR is its ability to improve patient care, impacting various participants in different ways.

Benefits to healthcare providers:
With FHIR, healthcare providers have access to more complete and accurate patient information, leading to better diagnoses and treatment plans. Additionally, FHIR can help reduce the number of duplicative tests and procedures, which can save time and money for patients and providers.

Benefits to public health:
Another benefit of FHIR is its ability to improve population health. With FHIR, public health officials have better access to more standardized, complete, and accurate information about the health of populations, which can help identify and address health disparities. This can lead to better-informed public health policies and interventions.

Benefits to research organizations:
With FHIR, patients can now share their health data directly with researchers in a standard format. Researchers can also have a standard data structure from EHRs to study large populations. Hopefully, this will lead to faster cures and improved outcomes for millions of patients.

Benefits to patients and their caregivers:
  • Empowerment: By having access to their health data, patients can better understand their health status, make more informed decisions about their care, and take a more active role in managing their health.

  • Improved Quality of Care: Patients can share their data with multiple providers, and this in turn can help providers to make more accurate and complete diagnoses and treatment plans. This is especially important during emergencies when timely access to health data is critical.

  • Better Coordination of Care: Patients can share their data with multiple providers, which helps to improve care coordination and continuity across different providers, especially for patients with complex medical conditions.

  • Increased Safety: Patients can access their data through FHIR apps, which can help to identify and prevent errors and improve the safety of their care.

  • Cost Savings: By giving patients access to their data, they can make better-informed decisions about their care, which can help to reduce healthcare costs.

  • Research: By allowing patients to share their data with researchers, it can help to accelerate medical discoveries and improve the development of new treatments and therapies.

How does MyLinks use FHIR?

MyLinks uses the FHIR standard to access data from EHRs who comply with the government mandate. MyLinks users can search for and locate their care provider from the tens of thousands of clinics listed in MyLinks. After locating their care provider, the user can then import their data into their own MyLinks account, giving the user their own “mini EHR”…only better. Their mini EHR is better because it is an aggregation of data from their multiple providers that is fully under their control.

How is the MyLinks FHIR application different from a clinic’s portal?

There are several important differences:

  • The data in a portal is owned by the health system. The portal data is a partial view into their system. You cannot add, delete, or edit the data.

  • If the health system changes their EHR or portal, your previous health data will likely be unavailable electronically.

  • Portals do not contain data from all your health systems. It is a fractured view of your health data. MyLinks provides you with a full view of all your data imported into your own record.

  • Data in a portal is often limited to whatever the health system wants to share. Government mandates require many more items to be shared with FHIR applications than are usually available in a portal.

  • Many portals do not share data immediately and may not share information for many days after it is available in the EHR. Government mandates require health organizations to give FHIR applications access to data immediately after it is entered into the EHR.

Sign up for a MyLinks account today and experience the difference. It's Free!

What is MyLinks' role in the development, maturity, and use of the FHIR standard?

MyLinks has been around since before FHIR started taking off in the United States. During the early days of FHIR, many EHRs, hospitals, and clinics, worked with MyLinks to test their FHIR implementation and ensure it was operational. MyLinks is also working with researchers and government organizations to mature the FHIR standards to improve data interoperability for patients to easily share their data with them.

MyLinks was one of the first consumer facing FHIR applications and won first place in a government contest for the best Consumer Health Data Aggregator.

FHIR continues to mature through HL7 workgroups who develop use cases where FHIR could benefit healthcare. These use cases are then tested at connectathons where engineers use the FHIR standards to share data among disparate systems. Once the FHIR resources have gone through vigorous testing, an implementation guide is developed so it can be used throughout the healthcare industry. The MyLinks team has been engaged in all these processes for many years.

2011 - Initial draft of FHIR as a blog

Grahame Grieve started writing the first version of Resources for Health, which would later be known as "FHIR".

2014 - Initial HL7 Release of FHIR

DSTU1 (First Draft Standard for Trial Use) was released.

2014 - October - Industry Report

Industry report known as JASON Task Force recommended the adoption of newer standards for data exchange. FHIR was a good fit per this recommendation.

2016 - ONC launches the Consumer Health Data Aggregator Challenge

The ONC launches the Consumer Health Data Aggregator Challenge to spur development of consumer-facing FHIR applications to help consumers aggregate their data in one place and under their control.

2017 - MyLinks wins First Place in the Consumer Health Data Aggregator Challenge

We were thrilled!

2018 - Da Vinci Project Started

A group of Health Plans, Providers, and EHRs came together to form the Da Vinci Project. This group focuses on solving interoperability issues using FHIR.

2018 - May - MyLinks goes live

MyLinks goes live to the public as health systems begin to implement the "FHIR API".

2019 - Release 4 Normitive for Select Resources

FHIR matured into its 4th version, known as FHIR R4 and gets cited in federal regulations.

2019 - HL7 Vulcan Accelerator Created

HL7 Vulcan Accelerator was started to bring together stakeholders to develop and mature FHIR resources for research use.

2019 - March - Final Rule by ONC/CMS

The ONC (Office of the National Coordinator) and the CMS (Centers for Medicare & Medicaid Services) finalized the rules as part of the Cures Act, that included FHIR as a requirement.

2021 - July - Health Plan Members Can Access Clinical and Claims via FHIR

Per the Cures Act Final Rule, patients can now access their clinical and claims data from payers like insurance companies via FHIR.

2021 - Helios Accelerator Started

Helios Accelerator was started to streamline data sharing across all levels of public health using FHIR.

2022 - December - G10 Certified EHRs Must Make FHIR R4 Available to Practices

As of December 2022, EHRs began rolling out FHIR R4 to their practices.

What is the ONC FHIR Mandate?

The Office of the National Coordinator for Health Information technology (ONC) is organizationally located within the Office of the Secretary for the U.S. Department of Health and Human Services (HHS). It is the principal federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information.

In the United States, the 21st Century Cures Act, passed in 2016, includes provisions that encourage the use of FHIR and other standards for exchanging healthcare information. The ONC’s Cures Act Final Rule requires healthcare providers and payers to make certain types of patient data available through an API (Application Programming Interface) that conforms to the FHIR standard by December 31, 2022.

Additionally, the mandate requires API Technology Suppliers to support the publication of service base URLs for all of its customers, and make such information publicly available, in a computable format, at no charge. This statement in the Cures Act, means EHRs and companies that manage FHIR for healthcare providers must publish a list of service base URLs, also known as "FHIR URLs" or "endpoints". FHIR developers can then use this information to setup and use a FHIR endpoint.

Not complying to this mandate may result in an “Information Blocking” claim against an EHR vendor, health care provider, or payer resulting in up to a $1 million penalty per violation. This mandate is intended to make it easier for patients to access their own healthcare information and to share it with other healthcare providers as needed.

What are "FHIR Resources"?

FHIR provides a set of "Resources" that represent various types of clinical concepts, such as patients, medications, and encounters. These resources can be easily exchanged between systems, making it simpler to share data between different EHR systems and other healthcare software applications. For example, a hospital's EHR system can easily share patient information with a primary care physician's EHR system, allowing for more coordinated and efficient care. The resources mandated by EHRs to support are driven by USCDI. The first version of USCDI mandated the following resources are made available to patients per the 21st Century Cures Act:

  • Allergies
  • Immunizations
  • Procedures
  • Labs
  • Medications
  • Smoking Status
  • Clinical Notes
  • Care Team Members
  • Goals
  • Patient Demographics
  • Unique Device Identifiers
  • Vital Signs
  • Health Concerns
  • Problems
  • Assessment & Plan of Treatment
  • Provenance

The elements of USCDI have been maturing and increasing over time. As of January 17, 2023, the ONC was working on USCDI V4. These advances occur as the FHIR technology matures and as more uses for the FHIR standard are found. USCDI v1 shown below.

Allergies and Intolerances
Harmful or undesired physiological responses associated with exposure to a substance.

  • Substance (Medication)
  • Substance (Drug Class)
  • Reaction

Assessment and Plan of Treatment
Health professional’s conclusions and working assumptions that will guide treatment of the patient.

  • Assessment and Plan of Treatment

Care Team Member(s)
Information on a person who participates or is expected to participate in the care of a patient.

  • Care Team Member(s)

Clinical Notes
Narrative patient data relevant to the context identified by note types.

  • Consultation Note
  • Discharge Summary Note
  • History & Physical
  • Procedure Note
  • Progress Note
  • Imaging Narrative
  • Laboratory Report Narrative
  • Pathology Report Narrative

Goals
Desired state to be achieved by a patient.

  • Patient Goals

Health Concerns
Health related matter that is of interest, importance, or worry to someone who may be the patient, patient’s family or patient’s health care provider.

  • Health Concerns

Immunizations
Record of vaccine administration.

  • Immunizations

Laboratory
Analysis of clinical specimens to obtain information about the health of a patient.

  • Tests
  • Values/Results

Medications
Pharmacologic agents used in the diagnosis, cure, mitigation, treatment, or prevention of disease.

  • Medications

Patient Demographics/Information
Data used to categorize individuals for identification, records matching, and other purposes.

  • First Name
  • Last Name
  • Middle Name (including middle initial)
  • Suffix
  • Previous Name
  • Date of Birth
  • Race
  • Ethnicity
  • Birth Sex
  • Preferred Language
  • Current Address
  • Previous Address
  • Phone Number
  • Phone Number Type
  • Email Address

Problems
Condition, diagnosis, or reason for seeking medical attention.

  • Problems

Procedures
Activity performed for or on a patient as part of the provision of care.

  • Procedures

Provenance
Metadata, or data that describes other data.

  • Author Time Stamp
  • Author Organization

Smoking Status
Representing a patient’s smoking behavior.

  • Smoking Status

Unique Device Identifier(s) for a Patient’s Implantable Device(s)
Unique identifier(s) for a patient's implantable device(s).

  • Unique Device Identifier(s) for a patient’s implantable device(s)

Vital Signs
Physiologic measurements of a patient that indicate the status of the body’s life sustaining functions.

  • Systolic Blood Pressure
  • Diastolic Blood Pressure
  • Heart Rate
  • Respiratory Rate
  • Body Temperature
  • Body Height
  • Body Weight
  • Pulse Oximetry
  • Inhaled Oxygen Concentration
  • BMI Percentile (2 - 20 years)
  • Weight-for-length Percentile (Birth - 36 Months)
  • Head Occipital-frontal Circumference Percentile (Birth - 36 Months)

What does FHIR look like?

It is based on RESTful web services and uses a simple, modular structure that allows for easy implementation and integration with other systems. The data is represented in a format called JSON (JavaScript Object Notation) which is human-readable, and can be easily processed by computers. Here's a code snippet that shows an example FHIR Allergy JSON object.

{
  "resourceType": "AllergyIntolerance",
  "id": "example",
  "text": {
    "status": "generated",
  "identifier": [
    {
      "system": "http://acme.com/ids/patients/risks",
      "value": "49476534"
    }
  ],
  "clinicalStatus": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
        "code": "active",
        "display": "Active"
      }
    ]
  },
  "verificationStatus": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
        "code": "confirmed",
        "display": "Confirmed"
      }
    ]
  },
  "type": "allergy",
  "category": [
    "food"
  ],
  "criticality": "high",
  "code": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "227493005",
        "display": "Cashew nuts"
      }
    ]
  },
  "patient": {
    "reference": "Patient/example"
  },
  "onsetDateTime": "2004",
  "recordedDate": "2014-10-09T14:58:00+11:00",
  "recorder": {
    "reference": "Practitioner/example"
  },
  "asserter": {
    "reference": "Patient/example"
  },
  "lastOccurrence": "2012-06",
  "note": [
    {
      "text": "The criticality is high becasue of the observed anaphylactic reaction when challenged with cashew extract."
    }
  ],
  "reaction": [
    {
      "substance": {
        "coding": [
          {
            "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
            "code": "1160593",
            "display": "cashew nut allergenic extract Injectable Product"
          }
        ]
      },
      "manifestation": [
        {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "39579001",
              "display": "Anaphylactic reaction"
            }
          ]
        }
      ],
      "description": "Challenge Protocol. Severe reaction to subcutaneous cashew extract. Epinephrine administered",
      "onset": "2012-06-12",
      "severity": "severe",
      "exposureRoute": {
        "coding": [
          {
            "system": "http://snomed.info/sct",
            "code": "34206005",
            "display": "Subcutaneous route"
          }
        ]
      }
    },
    {
      "manifestation": [
        {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "64305001",
              "display": "Urticaria"
            }
          ]
        }
      ],
      "onset": "2004",
      "severity": "moderate",
      "note": [
        {
          "text": "The patient reports that the onset of urticaria was within 15 minutes of eating cashews."
        }
      ]
    }
  ]
}}
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What is “SMART” in SMART on FHIR applications?

SMART stands for ‘Substitutable Medical Applications, Reusable Technologies’ and is an open-source, standards-based application programming interface (API) that leverages the OAuth 2.0 standard to provide secure, universal access to EHRs. The SMART platform builds on the existing FHIR platform.

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