Lighting a FHIR for holistic health data exchange
By: Sophie Bochaberi, Digital Square engagement officer
A laboratory technician logs information in the computer in the regional hospital laboratory in Thies, Senegal. Data standards such as FHIR® help enable easier, faster data exchange within and between healthcare systems. Photo: PATH/Gabe Bienczycki
As more low-resource countries increase uptake of digital health solutions to strengthen their health systems, it is imperative that these countries also integrate improved health data collection and use practices by adopting global health data standards.
Fast Health Interoperability Resources® (FHIR®), pronounced "fire" and developed by Health Level Seven International (HL7), is a global health standard that defines how health care information can be exchanged between different computer systems, regardless of how it is stored in those systems. As a result, FHIR can quickly parse, integrate, and exchange data between applications, systems, and locations, enabling seamless and on-demand health information exchange.
FHIR enables health workforce management
FHIR has seen unprecedented success around the globe and can be uniquely leveraged in low-resource settings to achieve more equitable health outcomes. “FHIR serves a culture of scarcity whereas many other standards are focused on cultures of abundance,” says José Costa Teixeira, Digital Square Standards and Interoperability Advisor.
“FHIR serves a culture of scarcity whereas many other standards are focused on cultures of abundance. ”
One such application of FHIR is with iHRIS. Developed by IntraHealth International, iHRIS is an open-source human resources information system for ministries of health to manage their health workforces. It is a digital health global good with deployments in more than 20 countries that manage over a million health worker records. Compared to commercial software, iHRIS generates a potential cost savings of over $275 million. Importantly, iHRIS is built with interoperability with other systems in mind. iHRIS conforms to various international standards—such as FHIR—to ensure that data that might otherwise be siloed are accessible to all parts of a health system for data exchange.
With investment from Digital Square, IntraHealth International recently released iHRIS version 5.0 based on FHIR, allowing this global good to easily connect to existing FHIR-compliant dashboard platforms such as District Health Information Software 2 (DHIS2), Power BI, and Tableau for integrated real-time reporting. As FHIR is adaptable to different contexts, iHRIS developers refine the interoperability standards of the software to meet the needs and use cases of the community and countries.
In Uganda, for example, IntraHealth supported combining iHRIS data with mobile phone technology to create a mobile directory. The directory allows citizens to send text messages to the Uganda Medical and Dental Practitioners Council to find out if a provider is registered with the council, licensed, and has a specialty.
Digital Square on FHIR
Digital Square partners with innovators—such as iHRIS developers—to increase the availability, adaptability, and maturity of high-quality software, service, and content tools to address country-driven health needs. To achieve this, the initiative advocates for increased interoperability through data sharing, ensuring that health information, from clinical to administrative data, is readily and securely accessible. Through Digital Square investments, 16 software global goods have increased their maturity.
The initiative strengthens global goods development through community engagement. Digital Square provides guidance and learning opportunities to help global goods developers and implementers better understand how to engage with FHIR and how to use this standard to address specific use cases.
Digital Square’s FHIR webinar series provides an overview and deep dive into how different global goods are using FHIR in their work.
To this end, in 2021 Digital Square kicked off a foundational FHIR webinar series. The series touched on the basics and gradually moved to more complex aspects of FHIR, while also showcasing how different global goods use FHIR in their work. For example, Instant OpenHIE and Open Health Information Mediator (OpenHIM) global goods collaborated to support COVID-19 case reporting and lab data exchange to a central FHIR server and DHIS2. This update had minimal impact on the existing systems while still meeting the unique country-specific contexts of Kenya and Uganda.
The aim of sharing this foundational knowledge and practical examples is to enhance and strengthen the capacity of the global goods community to easily navigate the FHIR ecosystem. Furthermore, it allows global goods partners to share and learn from each other’s best practices, thereby improving software quality, features, and interoperability.
Working closely with the global goods community means that Digital Square has a uniquely informed viewpoint, enabling the initiative to aggregate and highlight priorities raised by the community. For example, Digital Square has facilitated a global conversation with donors and investors about using FHIR as a preferred standard for data exchange in low- and middle-income countries.
Bringing FHIR to decision-makers' doorsteps
Digital Square aims to significantly impact the uptake and efficacy of FHIR in countries where digital health ecosystems are prime for standardization. We will actively engage government representatives, entrepreneurs, and implementers in low- and middle-income countries, providing a tailored approach for capacity strengthening.
We are building on our engagement with global goods and the FHIR webinar series, adapting and expanding existing content to offer deeper, more contextualized pieces of training for these different audiences. In addition, the initiative will leverage its partnership with the OpenHIE community to coordinate sharing and cross-learning. This approach aims to foster collaboration and alignment between government representatives and implementing partners, ultimately facilitating government commitment to incorporating the FHIR standard into development workflows at an early stage.
For many, seeing is believing. Digital Square will continue to elevate success stories of FHIR implementation, and we will also translate documentation from English into local languages to increase accessibility.
Ultimately, we believe data standardization will lead to more equitable health care systems and better health outcomes for all.