Implement an International Interoperable PHR by FHIR—A Taiwan Innovative Application

Abstract

Personal health records (PHRs) have lots of benefits for things such as health surveillance, epidemiological surveillance, self-control, links to various services, public health and health management, and international surveillance. The implementation of an international standard for interoperability is essential to accessing personal health records. In Taiwan, the nationwide exchange platform for electronic medical records (EMRs) has been in use for many years. The Health Level Seven International (HL7) Clinical Document Architecture (CDA) was used as the standard of the EMRs. However, the complication of implementing CDA became a barrier for many hospitals to realize the standard EMRs. In this study, we implemented a Fast Healthcare Interoperability Resources (FHIR)-based PHR transformation process including a user interface module to review the contents of PHRs. We used “My Health Bank, MHB”, a PHR data book developed and issued to all people by the Taiwan National Health Insurance, as the PHRs contents in this study. Network Time Protocol (NTP)/Simple Network Time Protocol (SNTP) was used in the security and user authentication mechanism when processing and applying personal health information. Transport Layer Security (TLS) 1.2 (such as HyperText Transfer Protocol Secure (HTTPS) was used for protection in data communication. User authentication is important in the platform. OAuth (OAuth 2.0) was used as a user authentication mechanism to confirm legitimate user access to ensure data security. The contents of MHB were analyzed and mapped to the FHIR, and then converted to FHIR format according to the mapping logic template. The function of format conversion was carried out by using ASP.NET. XPath and JSPath technologies filtered out specific information tags. The converted data structure was verified through an HL7 Application Programming Interface (HAPI) server, and a new JSON file was finally created. This platform can not only capture any PHR based on the FHIR format but also publish FHIR-based MHB records to any other platform to bridge the interoperability gap between different PHR systems. Therefore, our implementation/application with the automatic transformation from MHB to FHIR format provides an innovative method for people to access their own PHRs (MHB). No one has published a similar application like us using a nationwide PHR standard, MHB, in Taiwan. The application we developed will be very useful for a single person to use or for other system developers to implement their own standard PHR software.