FHIR, US Core, and Medplum: Navigating Healthcare Interoperability

In the constant flux of healthcare technology, interoperability remains a critical challenge. Developers and healthcare providers are constantly seeking ways to streamline data exchange and improve patient care. That’s where FHIR (Fast Healthcare Interoperability Resources), USCDI (United States Core Data for Interoperability), and US Core come into play – three game-changing standards that are reshaping how to approach healthcare data.

In this post, we'll explore these concepts, dive into FHIR Profiles, and see how Medplum, a robust open-source healthcare platform, ties it all together. Whether you're an experienced healthtech professional or just starting, stick around.

Understanding the Basics: FHIR, USCDI, and US Core

What is FHIR?

FHIR, pronounced "fire," is a standard created by HL7 (Health Level 7) for the electronic exchange of healthcare data. It's built to be flexible, adaptable, and easy to read, simplifying developers' implementation and promoting better interoperability between systems.

What is USCDI?

USCDI is a standardized set of health data classes and elements designed to support nationwide, interoperable health information exchange. Essentially, it's a list of key data points that should be shared across systems to ensure better coordination and communication.

What is US Core?

US Core is a collection of FHIR profiles and extensions that meet the USCDI requirements. It's the practical implementation of USCDI using FHIR, guaranteeing that systems can exchange essential patient data in a standardized manner.

Why Implement US Core?

Implementing the US Core is crucial for several reasons. In the first place, it helps healthcare organizations meet the requirements of the ONC Cures Act Final Rule, which mandates the implementation of USCDI.

The ONC Cures Act applies to healthcare providers, health IT developers, and health information networks or exchanges operating in the US healthcare industry to follow certain requirements. This regulatory compliance is critical for ensuring operability and interoperability throughout the healthcare ecosystem.

Beyond meeting regulatory obligations, adopting US Core significantly enhances interoperability by enabling systems to share data more seamlessly. This improved data sharing reduces integration complexity, minimizes errors, and ultimately enhances patient care, leading to more efficient healthcare delivery.

Furthermore, implementing internationally recognized standards like US Core helps future-proof healthcare systems by ensuring they can adapt to evolving technologies and maximize the value of existing investments. The use of standardized data formats improves data consistency and reliability across platforms, facilitating more accurate diagnoses, better treatments, and, ultimately, improved patient outcomes.

Deep Dive: FHIR Profiles

What are FHIR Profiles?

FHIR Profiles are a mechanism to customize the base FHIR resources for specific use cases. They enable us to define constraints and extensions on FHIR resources, adapting them to specific requirements while remaining compliant with the core standard. For instance, the US Core profiles, as previously mentioned, are a specific set of FHIR profiles that standardize data exchange within the US healthcare system.

Why Use FHIR Profiles?

FHIR Profiles offer several key advantages in healthcare data management by enabling the customization of FHIR to meet specific requirements without compromising interoperability. This flexibility allows diverse healthcare contexts to maintain a standardized approach.

Profiles also establish clear rules for data validation, ensuring consistency and quality across systems. This validation capability is essential for maintaining the integrity of healthcare data.

Another major advantage of FHIR Profiles is the clarity they bring to data requirements. By clearly outlining what information is needed, profiles enhance communication among stakeholders. This transparency reduces confusion and fosters better collaboration between teams and organizations handling healthcare data.

Finally, using FHIR Profiles enhances interoperability by ensuring that different implementations can work smoothly together. In the healthcare ecosystem, where seamless data exchange between systems and organizations is key, this compatibility plays a vital role in supporting coordinated and efficient patient care.

How to Use FHIR Profiles

Using FHIR Profiles involves a few key steps:

1. Identify Needs: Determine what customizations or constraints you need on top of the base FHIR resources;
2. Create or Adopt Profiles: Either create your own profiles or adopt existing ones like US Core;
3. Implement: Integrate the profiles into your FHIR server and client applications;
4. Validate: Use the profiles to validate incoming and outgoing data;
5. Document: Clearly communicate your profile usage to partners and stakeholders.

Medplum: Tie It All Together

At Vinta, we've been working extensively with Medplum, an open-source health platform that uses FHIR as its data standard, and supports US Core profiles.

Medplum's approach to profile management provides useful insights on how to efficiently implement these standards. By integrating US Core profiles, Medplum simplifies the process for developers to create applications that adhere to US healthcare standards, ensuring both compliance and streamlined development.

Practical Example: Implementing US Core Patient Profile

Let's look at a simple code example that shows how to create a patient resource using the US Core Patient profile in Medplum, as well as how to catch errors caused by missing data:

import { MedplumClient } from '@medplum/core';
import { Patient } from '@medplum/fhirtypes';

const medplum = new MedplumClient();

// Example of an incomplete patient (missing gender)
const incompletePatient: Patient = {
  resourceType: 'Patient',
  meta: {
    profile: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient']
  },
  identifier: [{
    system: 'http://hospital.smarthealthit.org',
    value: '1032702'
  }],
  name: [{
    family: 'Shaw',
    given: ['Amy']
  }],
  // Note: gender is missing, which is required by US Core
  birthDate: '1987-02-20'
};

// Attempt to create the patient
medplum.createResource(incompletePatient)
  .then((createdPatient) => {
    console.log('Patient created successfully:', createdPatient);
  })
  .catch((error) => {
    // This is where we catch errors, including those due to missing data
    console.error('Error creating patient:', error.message);
    // Here you would typically handle the error, such as by logging it or notifying the user
  });

This simplified example demonstrates several key points about working with US Core profiles and handling missing data in Medplum:

• Profile Specification: In the meta.profile field, we specify that this patient should follow the US Core Patient profile. This is crucial as it tells Medplum to validate the data against the US Core requirements;
• Incomplete Data: We've intentionally created a patient object that's missing the gender field, which is required by the US Core Patient profile. This simulates a typical real-world scenario in which data may be incomplete;
• Creation Attempt: We use Medplum's createResource method to attempt to create the patient. This method not only tries to create the resource but also validates it against the specified profile;
• Error Catching: The catch block in the promise chain is where we capture any errors that occur during the creation process. This includes validation errors due to missing required fields or other data issues.

It's important to note that while this example shows error catching at the point of resource creation, in many scenarios, you might want to validate the data before attempting to create the resource. Medplum provides a validateResource function that can be used for this purpose.

Here's how you might use it:

import { validateResource } from '@medplum/core';

// ... [rest of the code]

// Validate the resource before attempting to create it
const validationResult = await validateResource(incompletePatient);

if (validationResult.success) {
  // Proceed with resource creation
  medplum.createResource(incompletePatient)
    .then(/* ... */)
    .catch(/* ... */);
} else {
  console.log('Validation failed:', validationResult.messages);
  // Handle validation errors
}

validateResource is handy for providing immediate feedback to users or implementing more elaborate error-handling logic.

In a production environment, you would replace the simple console logging with more robust error handling.

This might include:

• Logging the error details for later analysis;
• Notifying the user about the specific missing or invalid data;
• Attempting to correct the data automatically if possible;
• Storing the incomplete data for later completion.

By understanding where and how to catch these errors, you can ensure that your application maintains data quality and compliance with the US Core profile, while also providing a smooth user experience when dealing with incomplete or invalid data.

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Conclusion

As we navigate the complex world of healthcare interoperability, standards like FHIR, USCDI, and US Core, along with tools like FHIR Profiles and platforms like Medplum, are valuable. They provide a standard language for healthcare systems, ensuring that essential patient data is communicated correctly and securely.

Vinta's expertise with Medplum and these standards has demonstrated their practical value in developing robust, interoperable healthcare solutions. As the healthcare technology landscape evolves, adopting these standards and technologies will be critical for developers and organizations seeking to improve patient care through greater data interchange.

Keep in mind that while full interoperability is still a work in progress, every step we take in adopting and implementing these standards brings us closer to a more connected and efficient healthcare ecosystem.