Validation and Testing of Fast Healthcare Interoperability Resources Standards Compliance: Data Analysis

BACKGROUND: There is wide recognition that the lack of health data interoperability has significant impacts. Traditionally, health data standards are complex and test-driven methods played important roles in achieving interoperability. The Health Level Seven International (HL7) standard Fast Healthcare Interoperability Resources (FHIR) may be a technical solution that aligns with policy, but systems need to be validated and tested. OBJECTIVE: Our objective is to explore the question of whether or not the regular use of validation and testing tools improves server compliance with the HL7 FHIR specification. METHODS: We used two independent validation and testing tools, Crucible and Touchstone, and analyzed the usage and result data to determine their impact on server compliance with the HL7 FHIR specification. RESULTS: The use of validation and testing tools such as Crucible and Touchstone are strongly correlated with increased compliance and "practice makes perfect." Frequent and thorough testing has clear implications for health data interoperability. Additional data analysis reveals trends over time with respect to vendors, use cases, and FHIR versions. CONCLUSIONS: Validation and testing tools can aid in the transition to an interoperable health care infrastructure. Developers that use testing and validation tools tend to produce more compliant FHIR implementations. When it comes to health data interoperability, "practice makes perfect.