The HL7 EHR System Functional Model provides a reference list of functions that may be present in an Electronic Health Record System. While FHIR is an implementation focused on exchange of information in healthcare, this often happens in the context of an EHR. This table briefly describes one way that FHIR can be used to meet the requirements described in the EHR-FM and is provided to help readers of the FHIR specification understand how FHIR can be used. There are many other equally valid ways to implement the EHR-FM and to make use of FHIR.
EHR
Function
EHR Function
|
FHIR
Implementation
Notes
FHIR Implementation Notes
|
|
IN.1
|
Security
|
FHIR
defines
parts
of
the
security
infrastructure,
and
delegates
others
to
standard
web
based
security
frameworks
FHIR defines parts of the security infrastructure, and delegates others to standard web based security frameworks
|
|
IN.1.1
|
Entity
Authentication
Entity Authentication
|
FHIR
assumes
that
the
users
are
authenticated.
OAuth
is
the
preferred
mechanism
FHIR assumes that the users are authenticated. OAuth is the preferred mechanism
|
|
IN.1.2
|
Entity
Authorization
Entity Authorization
|
FHIR
does
not
currently
provide
any
resources
to
describe
or
manage
access-control
permissions.
By
default,
underlying
web
frameworks
such
as
SAML
would
be
used.
See
the
security
section
for
a
discussion
of
binding
between
FHIR
and
SAML
FHIR does not currently provide any resources to describe or manage access-control permissions. By default, underlying web frameworks such as SAML would be used. See
the security section
for a discussion of binding between FHIR and SAML
|
|
IN.1.3
|
Entity
Access
Control
Entity Access Control
|
See
above
about
SAML
/
OAuth
See above about SAML / OAuth
|
|
IN.1.4
|
Patient
Access
Management
Patient Access Management
|
See
Security
Labels
See
Security Labels
|
|
IN.1.5
|
Non-Repudiation
|
The
provenance
resource
tracks
the
timestamps,
actors,
digital
signatures
associated
with
resources
The
provenance resource
tracks the timestamps, actors, digital signatures associated with resources
|
|
IN.1.6
|
Secure
Data
Exchange
Secure Data Exchange
|
TLS
(https:)
should
be
used
for
all
production
exchange
of
data.
All
conformant
FHIR
RESTful
implementations
SHALL
be
able
to
use
TLS
TLS (https:) should be used for all production exchange of data. All conformant FHIR RESTful implementations SHALL be able to use TLS
|
|
IN.1.7
|
Secure
Data
Routing
Secure Data Routing
|
FHIR
allows
for
brokers
and
various
forms
of
messaging
that
support
assured
destinations
and
delivery
(also
see
IN.2.2
below)
FHIR allows for brokers and various forms of messaging that support assured destinations and delivery (also see IN.2.2 below)
|
|
IN.1.8
|
Information
Attestation
Information Attestation
|
See
the
provenance
resource
See the
provenance resource
|
|
IN.1.9
|
Patient
Privacy
and
Confidentiality
Patient Privacy and Confidentiality
|
FHIR
does
not
include
functionality
related
to
this
requirement,
though
implementations
would
be
expected
to
provide
this
FHIR does not include functionality related to this requirement, though implementations would be expected to provide this
|
|
IN.2
|
Health
Record
Information
and
Management
Health Record Information and Management
|
This
is
a
core
application
of
the
FHIR
capabilities
This is a core application of the FHIR capabilities
|
|
IN.2.1
|
Data
Retention,
Availability
and
Destruction
Data Retention, Availability and Destruction
|
A
FHIR
RESTful
server
gives
precise
and
fine-grained
control
of
retention,
availability
and
destruction
of
resources,
all
clearly
described
by
the
conformance
statement
A FHIR RESTful server gives precise and fine-grained control of retention, availability and destruction of resources, all clearly described by the conformance statement
|
|
IN.2.2
|
Auditable
Records
Auditable Records
|
FHIR
provides
the
FHIR provides the
AuditEvent
resource
for
auditable
records.
resource for auditable records.
|
|
IN.2.3
|
Synchronization
|
FHIR
supports
synchronization
using
standard
web
publication/subscription
methods
via
FHIR supports synchronization using standard web publication/subscription methods via
Bundles
.
Bundle-based
pub/sub
may
be
push
or
pull
based,
and
can
include
all
resources
of
a
particular
type,
or
selected
subsets
of
the
resources.
In
addition,
groups
of
resources
can
be
exchanged
in
bundles,
keeping
a
set
of
related
resources
in
synchronization
. Bundle-based pub/sub may be push or pull based, and can include all resources of a particular type, or selected subsets of the resources. In addition, groups of resources can be exchanged in bundles, keeping a set of related resources in synchronization
|
|
IN.2.4
|
Extraction
of
Health
Record
Information
Extraction of Health Record Information
|
FHIR
does
not
provide
report
formats,
but
does
provide
extensive
search
and
retrieval
functions
to
assist
with
building
such
reports
FHIR does not provide report formats, but does provide extensive search and retrieval functions to assist with building such reports
|
|
IN.2.5
|
Store
and
Manage
Health
Record
Information
Store and Manage Health Record Information
|
A
FHIR
RESTful
server
can
store
and
manage
health
information
persistently
-
see
below
for
further
information.
A FHIR RESTful server can store and manage health information persistently - see below for further information. |
|
IN.2.5.1/2
|
Manage
Structured
and
Unstructured
Health
Record
Information
Manage Structured and Unstructured Health Record Information
|
The
dual
contents
of
FHIR
resources
-
structured
data
and
XHTML
narrative
-
provide
seamless
support
for
dealing
with
a
mix
of
structured
and
unstructured
information
The dual contents of FHIR resources - structured data and XHTML narrative - provide seamless support for dealing with a mix of structured and unstructured information
|
|
IN.3
|
Registry
and
Directory
Services
Registry and Directory Services
|
The
FHIR
Administration
resources
provide
a
registry
based
access
to
patients,
providers,
etc.
The FHIR
Administration resources
provide a registry based access to patients, providers, etc.
|
|
IN.4
|
Standard
Terminologies
and
Terminology
Services
Standard Terminologies and Terminology Services
|
FHIR
encourages
the
use
of
standard
terminologies
wherever
possible,
and
provides
full
support
for
their
use
through
a
variety
of
terminology
related
data
types
.
FHIR
defines
a
terminology
service
infrastructure
.
Also,
see
FHIR encourages the use of standard terminologies wherever possible, and provides full support for their use through a variety of terminology related
data types
. FHIR defines
a terminology service infrastructure
. Also, see
profiling
,
which
discusses
how
terminology
is
used
in
a
FHIR
context
, which discusses how terminology is used in a FHIR context
|
|
IN.5
|
Standards-based
Interoperability
Standards-based Interoperability
|
FHIR
is
a
definition
of
a
standard
on
which
to
base
interoperability
FHIR is a definition of a standard on which to base interoperability
|
|
IN.5.1
|
Interchange
Standards
Interchange Standards
|
This
is
the
core
focus
of
FHIR.
See
below
for
discussion
of
interaction
modes
This is the core focus of FHIR. See below for discussion of interaction modes
|
|
IN.5.2
|
Interchange
Standards
Versioning
and
Maintenance
Interchange Standards Versioning and Maintenance |
FHIR
version
maintenance
is
described
here
FHIR version maintenance is
described here
|
|
IN.5.3
|
Standards-based
Application
Integration
Standards-based Application Integration
|
FHIR
enables
simple
integration
through
use
of
an
easy
to
understand,
use
and
debug
web-based
infrastructure.
The
same
framework
used
within
an
EHR
for
persistence
can
also
offer
a
simple
way
to
implement
exchange
FHIR enables simple integration through use of an easy to understand, use and debug web-based infrastructure. The same framework used within an EHR for persistence can also offer a simple way to implement exchange
|
|
IN.5.4
|
Interchange
Agreements
Interchange Agreements
|
The
FHIR
Conformance
Statement
and
Resource
Profile
resources
provide
a
registry
based
infrastructure
for
individual
trading
partner
agreements,
as
well
as
for
community
based
ones
The FHIR Conformance Statement and Resource Profile resources provide a registry based infrastructure for individual trading partner agreements, as well as for community based ones
|
|
IN.6
|
Business
Rules
Management
Business Rules Management
|
FHIR
does
not
address
this
requirement
at
this
point
in
time
FHIR does not address this requirement at this point in time
|
|
IN.7
|
Workflow
Management
Workflow Management
|
FHIR
does
not
address
this
requirement
at
this
point
in
time,
though
the
resources
and
services
exist
to
support
this
functionality
FHIR does not address this requirement at this point in time, though the resources and services exist to support this functionality
|
The
EHR
functional
model
describes
several
modes
for
interaction
between
systems.
Each
of
these
can
be
implemented
in
several
different
ways
using
FHIR
The EHR functional model describes several modes for interaction between systems. Each of these can be implemented in several different ways using FHIR
Interaction
Modes
Interaction Modes
|
FHIR
Options
FHIR Options
|
Unsolicited
Notifications
Unsolicited Notifications
e.g.
a
patient
has
arrived
for
a
clinic
appointment
e.g. a patient has arrived for a clinic appointment |
-
create/update
new
resource
via
HTTP
create/update new resource via HTTP
-
push
resources
using
Bundle
push resources using Bundle
-
Send
FHIR
Send FHIR
Message
(if
appropriate
event
is
defined)
(if appropriate event is defined)
|
Query/Response
e.g.
Is
Adam
Everyman
known
to
the
system?
Yes,
MRN
is
12345678.
e.g. Is Adam Everyman known to the system? Yes, MRN is 12345678.
|
-
search
with
parameters
search with parameters
-
A
query
message
(though
not
defined
yet)
A query message (though not defined yet)
|
Service
Request
and
Response
Service Request and Response
e.g.
Laboratory
Order
for
Fasting
Blood
Sugar
and
a
response
containing
the
results
of
the
test.
e.g. Laboratory Order for Fasting Blood Sugar and a response containing the results of the test. |
Could
be
supported
either
through
Messaging
or
SOA
solutions.
Request/Response
support
is
not
yet
defined
Could be supported either through Messaging or SOA solutions. Request/Response support is not yet defined
|
Information
Interchange
between
organizations
(e.g.
in
a
RHIO,
or
in
a
National
Health
System)
Information Interchange between organizations (e.g. in a RHIO, or in a National Health System) |
-
pub/sub
using
bundles
(push
or
pull)
pub/sub using bundles (push or pull)
-
RESTful
interface
RESTful interface
-
FHIR
messaging
FHIR messaging
|
Structured
/
Unstructured
clinical
document,
e.g.
dictated
surgical
note
Structured / Unstructured clinical document, e.g. dictated surgical note |
See
the
See the
Documents
|
The
combination
of
a
properly
secured
and
managed
FHIR
server,
along
with
enforced
use
of
the
Additional functionality, not defined at this point in time in FHIR, is required to ensure non-repudiation, access control, and consent tracking.
