Using HL7® FHIR® in Critical Care – Benefits, Gaps and Strategies

As healthcare organizations increasingly adopt the HL7^® FHIR^® standard, it’s important to examine its impact on each area of care. Accordingly, in this article, I will explore the potential of HL7 FHIR to contribute to the improvement of the critical care department.

As many HL7 FHIR resources were developed with an outpatient context in mind—focusing on areas such as scheduling and routine documentation—local profiling and customization may be necessary to meet the unique requirements of critical care.

By making it easier to exchange and use healthcare information, FHIR helps ensure that critical care providers can access the information they need to optimally care for their patients. Moreover, the standardized data formats and exchange protocols of FHIR can align well with critical care systems if well understood and properly implemented. By enabling seamless data flow between different systems, FHIR promotes the interoperability that is crucial for timely and coordinated care of critically ill patients.

What you will learn

• The role of FHIR in critical care
• The importance of mapping use cases
• The impact of local and national FHIR profiles
• How clinical and technical teams should collaborate to leverage FHIR in critical care

What is FHIR?

FHIR (Fast Healthcare Interoperability Resources) was originally proposed by HL7 International in 2011 and is now a widely used standard for exchanging healthcare information electronically. Benefits of using HL7 FHIR include improved interoperability, increased efficiency, enhanced patient engagement, and easier development of new healthcare applications. However, its adoption is not without challenges, as technical and use case complexities can complicate implementation.

The importance of FHIR to critical care

FHIR enables on-demand data exchange between diverse sources—a vital feature in critical care environments. It lets specialized systems and applications work together seamlessly enabling clinical staff to apply the best available applications while maintaining a complete picture of the patient’s condition and treatment.

FHIR integrations can be used in critical care to enhance clinical decision support, improve care coordination, and streamline data analysis, which can improve outcomes for critically ill patients and contribute to more efficient use of healthcare resources.

Critical use cases for FHIR in intensive care

Implementing FHIR in critical care begins with mapping relevant clinical needs, which often vary by hospital. Since many FHIR resources aren’t originally designed for critical care, adjustments are often necessary.

For instance, MedicationRequest and MedicationStatement resources suit outpatient oral tablet orders but they may lack details for case-dependent infusions and injections common in critical care.

Additionally, the high volume of critical care data means that deploying FHIR APIs without a clear use case can overload integrations. For example, when transferring a patient to a step-down unit, should the system deliver the complete observation history or just the most recent data?

Tailoring FHIR to specific clinical scenarios is essential to adding value for clinicians and preventing IT environment overload.

How do critical care use cases differ from other departments

In critical care wards, patients require the most intensive level of care, resulting in data that is:

1. More complex – e.g., medication orders involve more intricate mixtures and more complicated schedules.
2. More voluminous – Continuous monitoring generates hundreds of data parameters per minute plus frequent manual documentation.

Common FHIR use cases in critical care include:

• Coordinating medication orders across systems
• Synchronizing patient movements and demographics
• Tracking patient vital signs history
• Transferring discharge summaries for continued treatment
• Reporting treatment and condition histories to national registries
• Sharing treatment and medication data with billing systems for accurate reimbursement

 

FHIR can benefit many continuum of care activities, such as viewing, transitioning, defining, and adapting medication care, nursing tasks, lines, and drains.

One global FHIR standard, many local implementations

FHIR is defined by local profiles to allow for necessary variations in data representation and usage across different healthcare systems and regions while maintaining a core level of interoperability. Many countries have their own FHIR organization that works on standardizing FHIR locally, such as Nictiz in the Netherlands, HL7 Norway, the Israeli FHIR community (FHIR-IL), and HL7 Australia.

Practical implications of differing national or local profiles

Localized profiles add complexity at multiple levels, from terminology, to how integrations are implemented. Even seemingly simple aspects can vary greatly. Definitions of common terms like “Patient”, “Encounter”, and “Medication” may vary by country.

Another example of local variances is that patients may be linked to a national ID in some countries, while in other countries no individual specific identifier may be available. Local profiling sets consistent rules, such as linking treatment encounters and other information to each patient, in a manner that allows individuals’ data to be tracked across systems and locations.

Medication databases may also differ in how products are linked to active ingredients. Coordinating this is essential for ensuring that medication interaction and duplicate medication warnings are activated correctly.

How to find local profiles in your location

For guidance, consult the HL7^® FHIR^® Implementation Guide Registry or use Simplifier to find local profile structures.

Designing systems for a dynamic FHIR environment

The variety of profiles demands flexible solutions. Vendors may interpret FHIR differently. While a radiology system may group patient data by patient, a clinical information system (CIS) might center on the care encounter. Therefore, a CIS must allow dynamic linkage of data across systems and devices in a way that fits the intended use case.

Additionally, it’s important to keep the use cases in mind and add only the requirements that matter to critical care clinicians. This can be done to high specificity while balancing clinical and IT needs. For instance, when a patient arrives in the critical care ward, it’s typically meaningful to see lab data from the last 7 days; but providing 30-day data may be valuable only in edge cases, excessively straining the IT infrastructure.

The role of integration platforms

Integration platforms can expand the capabilities of the clinical information system to increase flexibility. For example, identifiers can be generated and converted, and data can be retrieved and transmitted on events that may not be natively supported.

Practical considerations when evaluating CIS vendors

Understanding the current state of the local or national profile should be the starting point for evaluating any FHIR-based implementation. After mapping your use cases, it is vital to check if the local standard covers them in a way that fits critical care.

Discuss with the system vendor whether these features exist in the system, or if configuration or utilization of an integration engine is needed.

Key takeaways

• By standardizing healthcare data exchange, HL7 FHIR improves the interoperability of devices and systems, supporting improved clinical decision-making and care coordination.
• Many FHIR resources are designed for outpatient settings and require adjustments for critical care.
• Mapping specific clinical use cases is crucial for effective FHIR integration in critical care.
• FHIR implementations must consider localized profiles to support critical care-specific interoperability that meets the local clinical practice and regulatory requirements.
• Successful implementation depends on strong collaboration between clinicians and IT.

Conclusion: Tips for aligning critical care and HL7 FHIR

FHIR uses modern web technologies to standardize and simplify healthcare data exchange. It holds great value for critical care, but its effectiveness relies on deep coordination and communication between clinicians and IT.

It is crucial to map and stick to use cases, to prevent scope creep to data exchange that doesn’t serve the main use case in a meaningful way. Mapping to local FHIR profiles ensures that healthcare data exchange complies with specific national regulations, standards, and clinical practices, enabling data sharing across the healthcare ecosystem.

Note: HL7^®, and FHIR^® are the registered trademarks of Health Level Seven International, and the use of these trademarks does not constitute an endorsement by HL7.

FAQs

• How does FHIR relate to critical care patient data management systems?

  HL7® FHIR® provides a standardized framework for representing and exchanging healthcare data. It facilitates the ability to exchange and interpret critical patient information, such as vital signs, lab results, and medications. This interoperability allows for a comprehensive and up-to-date view of the critical care patient's condition, improving clinical decision-making and care coordination.

• How can FHIR be used to improve the quality of ICU patient care?

  In critical care, seamless data flow and integration are paramount for timely and effective patient care. By allowing different healthcare systems to easily share information, a patient's data can be accessed and understood by any system that uses HL7 FHIR, which can improve workflows, decision-making, care coordination, and patient safety.

• How to overcome FHIR challenges in critical care data management systems?

  Overcoming FHIR implementation challenges in critical care requires strategic planning, mapping of use cases, phased rollouts, comprehensive training programs for clinicians, and robust data governance frameworks to address security and standardization concerns. Collaboration between IT specialists, clinicians, and vendors is crucial for successful integration, workflow optimization, and ongoing system maintenance.