Enabling Tiered and Coordinated Services in a Health Community of Primary Care Facilities and County Hospitals Based on HL7 FHIR

The HL7 FHIR is an emerging international standard designed to facilitate the interoperability among IT systems of healthcare providers' and other stakeholders'. The implementation of interoperability relies on three key elements: unified data standards, API specifications and the coordinated scheduling. In this paper, we addressed the interoperability between a health community of primary care facilities and county hospitals in China, which usually adopted diversified legacy health IT systems from different vendors over the years. We designed a series of open service FHIR API specifications targeting seven prior applications commonly encountered in such a community, as well as developed an integration service platform (ISPf) to serve these APIs. The seven scenarios included outpatient appointment process, two-way referrals, access to regional LIS, access to regional PACS, retrieval of medical service history, payment request and access to PHR. Each care institution needs to access the ISPf as per open service API specifications. The ISPf provides API authorization, calling and secure management services among healthcare providers. Our work demonstrated an open, flexible, effective and standards complied approach to promoting health IT systems' interoperability to enable tiered and coordinated healthcare services to the great benefit of under-served citizens.