A Preliminary Implementation of HL7 FHIR to Achieve Interoperability in Indonesia's Local EHR

Abstract

Electronic Health Records (EHR) presents opportunities to improve interoperability between healthcare services. Interoperability is needed by the primary health centers in Indonesia to enable seamless transfer of patient's health records across healthcare facilities. However, the development of EHR in Indonesia makes interoperability difficult to achieve because it is built differently among healthcare services. This study aims to explore the feasibility of implementing the HL7 FHIR standard in the Indonesian primary health center's EHR. Fast Healthcare Interoperability Resources (FHIR) is a health interoperability standard developed by HL7 that supports syntactic interoperability upon the concept of resources and API. This interoperability standard helps to build the bridge to enable coordination between different systems. In this study, we implemented an EHR client-server prototype to simulate the exchange of health data using the FHIR resources and REST API. The health data messages were modeled and structured as a FHIR resource. The calculation of content overlap shows that only 65.8% of local health data can be represented as a FHIR resource. We did the profiling to further adapt the use of FHIR resources to meet Indonesia's health data requirements. The extensions were added to represent the local data elements that FHIR resources cannot cover. This preliminary study showed that FHIR implementation is possible in Indonesia's primary health centers. The implementation of 111.7 FHIR using FHIR resources, profile, and REST API supports the syntactic and semantic interoperability. It can provide quality data to support the referral system, analysis purposes, and health decision-making.