HL7 Fast Healthcare Interoperability Resources (HL7 FHIR) in digital healthcare ecosystems for chronic disease management: Scoping review

  • Int J Med Inform. 2024 Sep:189:105507. doi: 10.1016/j.ijmedinf.2024.105507.
Roberta Gazzarata  1 ,  Joao Almeida  2 ,  Lars Lindsköld  3 ,  Giorgio Cangioli  4 ,  Eugenio Gaeta  5 ,  Giuseppe Fico  6 ,  Catherine E Chronaki  7
Affiliations
  • 1. HL7 Europe Foundation, 38-40 Square de Meeus, Brussels, 1000, Belgium; Healthropy Srl, Corso Vittorio Veneto 14B, Savona, 17100, Italy. Electronic address: [email protected].
  • 2. HL7 Europe Foundation, 38-40 Square de Meeus, Brussels, 1000, Belgium; MEDCIDS - Faculty of Medicine of University of Porto, Porto, Portugal; PDH - Pharma Data Hub, Porto, Portugal. Electronic address: [email protected].
  • 3. European Federation for Medical Informatics, Ch de Maillefer 37, CH-1052 Le Mont-sur-Lausanne, Switzerland; SciLifeLab Datacenter, University of Uppsala, S-752 37 Uppsala, Sweden. Electronic address: [email protected].
  • 4. HL7 Europe Foundation, 38-40 Square de Meeus, Brussels, 1000, Belgium. Electronic address: [email protected].
  • 5. Life Supporting Technologies, Universidad Politécnica de Madrid, Avenida Complutense 30, 28040 Madrid, Spain. Electronic address: [email protected].
  • 6. Life Supporting Technologies, Universidad Politécnica de Madrid, Avenida Complutense 30, 28040 Madrid, Spain. Electronic address: [email protected].
  • 7. HL7 Europe Foundation, 38-40 Square de Meeus, Brussels, 1000, Belgium; European Federation for Medical Informatics, Ch de Maillefer 37, CH-1052 Le Mont-sur-Lausanne, Switzerland. Electronic address: [email protected].
PMID: 38870885 DOI: 10.1016/j.ijmedinf.2024.105507
Abstract

Background: The prevalence of chronic diseases has shifted the burden of disease from incidental acute inpatient admissions to long-term coordinated care across healthcare institutions and the patient's home. Digital healthcare ecosystems emerge to target increasing healthcare costs and invest in standard Application Programming Interfaces (API), such as HL7 Fast Healthcare Interoperability Resources (HL7 FHIR) for trusted data flows.

Objectives: This scoping review assessed the role and impact of HL7 FHIR and associated Implementation Guides (IGs) in digital healthcare ecosystems focusing on chronic disease management.

Methods: To study trends and developments relevant to HL7 FHIR, a scoping review of the scientific and gray English literature from 2017 to 2023 was used.

Results: The selection of 93 of 524 scientific papers reviewed in English indicates that the popularity of HL7 FHIR as a robust technical interface standard for the health sector has been steadily rising since its inception in 2010, reaching a PEAK in 2021. Digital Health applications use HL7 FHIR in Cancer (45 %), Cardiovascular Disease (CVD) (more than 15 %), and diabetes (almost 15 %). The scoping review revealed that references to HL7 FHIR IGs are limited to ∼ 20 % of articles reviewed. HL7 FHIR R4 was most frequently referenced when the HL7 FHIR version was mentioned. In HL7 FHIR IGs registries and the internet, we found 35 HL7 FHIR IGs addressing chronic disease management, i.e., Cancer (40 %), chronic disease management (25 %), and diabetes (20 %). HL7 FHIR IGs frequently complement the information in the article.

Conclusions: HL7 FHIR matures with each revision of the standard as HL7 FHIR IGs are developed with validated data sets, common shared HL7 FHIR resources, and supporting tools. Referencing HL7 FHIR IGs cataloged in official registries and in scientific publications is recommended to advance data quality and facilitate mutual learning in growing digital healthcare ecosystems that nurture interoperability in digital health innovation.

Keywords
Chronic diseases; Digital healthcare ecosystems; Digital transformation; HL7 FHIR Implementation Guide; Interoperability standards; Living environments.