Fast Healthcare Interoperability Resources (FHIR) for Clinical, Epidemiological and Public Health Research: A Systematic Review

Abstract

Background: The standard Fast Healthcare Interoperability Resources (FHIR) is widely used in health information technology, however, its use as a standard for health research is still less prevalent. This article reports the current usage of FHIR in clinical, epidemiological and public health research. Methods: In this systematic review, we searched PubMed/Medline, EMBASE, Web of Science, IEEE Xplore and the Cochrane Library databases for studies published from 2010 to 2021. Studies investigating the use of FHIR in health research were included. Articles published before 2010, abstracts, reviews, editorials and expert opinions were excluded. We followed the PRISMA guidelines and registered this study with PROSPERO, CRD42021235393 Data synthesis was done in tables and figures. Findings: We identified a total of 674 studies, of which 28 studies were eligible for inclusion. Most studies covered the domain of clinical research (22/28) while the remaining studies focused on public health/ Epidemiology (3/28) or did not specify their research domain (3/28). Studies used FHIR for data capture (11/28), standardization of data (7/28), analysis (4/28), recruitment (4/28) and consent management (2/28). Most studies had a generic approach (15/28) and nine of 13 studies focusing on specific medical specialties (infectious disease, genomics, oncology, environmental health, imaging, pulmonary hypertension) reported their solutions to be conferrable to other use cases. Half of the studies reported using additional data models or terminologies: SNOMED CT (8/14), LOINC (8/14), ICD-10 (6/14), OMOP CDM (3/14) and others (9/14). Interpretation: Our review found that FHIR can be implemented in clinical as well as public health research and Epidemiology. The areas of application are broad and generalizable in most use cases. However, for interoperable health research, other standards are needed using hybrid approaches, and limitations such as change of FHIR content, lack of FHIR implementation, safety and legal matters need to be addressed in the future. Funding Statement: German Research Foundation (DFG) Declaration of Interests: S.T. is chair of HL7 Deutschland e.V. The remaining authors declare no competing interests.