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HL7 / FHIR

HL7 / FHIR

Health Level 7 & Fast Healthcare Interoperability Resources

1. Overview of HL7/FHIR, the Healthcare Interoperability Standard for Securely Exchanging Clinical Data Between Medical Systems

    flowchart LR
    A["Fragmented, non-standard<br/>EMRs per institution —<br/>hard to interconnect data"] --"HL7 FHIR —<br/>a RESTful API standard"--> B["Resource-based<br/>standardization of health data"] --"Interoperability<br/>achieved"--> C["An integrated<br/>digital healthcare platform"]

    style A fill:#FFEBEE,stroke:#D32F2F,color:#000
    style B fill:#E3F2FD,stroke:#1976D2,color:#000
    style C fill:#E8F5E9,stroke:#388E3C,color:#000
  

Definition: HL7 (Health Level 7) is the international standards body for healthcare information exchange. Its most recent standard, FHIR (Fast Healthcare Interoperability Resources), is a RESTful-API-based, resource-level standard for exchanging health data — a framework that enables secure, consistent sharing of patient information and clinical data between hospital information systems.

Characteristics: (RESTful API-based) Exchanges health data in JSON/XML over standard web methods, far easier to implement than legacy HL7 v2/v3. (Resource-centric) Defines around 80 standard resources such as Patient, Observation, and MedicationRequest. (Regulatory mandate) FHIR support is legally mandated under US ONC (Office of the National Coordinator for Health IT) and CMS rules; Korea’s health ministry is pursuing similar requirements.

Evolution of HL7 Standard Versions

VersionCharacteristicsKey Use
HL7 v2Pipe-delimited message format, established in 1987Still widely used to connect domestic hospital HIS/LIS systems
HL7 v3XML-based; complex structure made adoption difficultLimited use
FHIR R4REST/JSON/API-based; the current mainstream standardThe baseline standard for global digital healthcare platforms
FHIR R5Stronger subscription model, improved smart-app integrationPlanned for next-generation medical AI/PHR platforms

2. Core Structure of HL7 FHIR

A. FHIR’s Core Components

    flowchart TD
    subgraph R1[" "]
        direction LR
        RES["Resource<br/>Patient, Observation,<br/>MedicationRequest, Encounter —<br/>around 80 standard resources"]
        API["RESTful API<br/>CRUD-based standard operations —<br/>GET/POST/PUT/DELETE,<br/>JSON/XML formats"]
    end
    subgraph R2[" "]
        direction LR
        PRF["Profile<br/>defines country/institution-specific<br/>constraints — Korea FHIR IG,<br/>supports Extensions"]
        SEC["Security/authentication<br/>SMART on FHIR —<br/>OAuth 2.0/OpenID Connect,<br/>patient-consent-based access"]
    end

    style RES fill:#E3F2FD,stroke:#1976D2,color:#000
    style API fill:#F3E5F5,stroke:#7B1FA2,color:#000
    style PRF fill:#FFF3E0,stroke:#F57C00,color:#000
    style SEC fill:#E8F5E9,stroke:#388E3C,color:#000
    style R1 fill:none,stroke:none
    style R2 fill:none,stroke:none
  

Key FHIR Resource Categories

CategoryResourcesDescription
Patient informationPatient, RelatedPersonPatient demographics, guardian information
Clinical informationObservation, Condition, ProcedureTest results, diagnosis, treatment history
MedicationMedicationRequest, MedicationDispensePrescription, administration, dispensing information
Care recordsEncounter, EpisodeOfCareVisit, admission, and outpatient episodes
Diagnostic imagingImagingStudy, DiagnosticReportDICOM linkage, image interpretation
Administrative informationOrganization, Practitioner, LocationInstitution, clinician, and facility information

B. Digital Healthcare Data Integration and Application

    flowchart LR
    subgraph SRC["Data Sources"]
        direction TB
        S1["EMR/HIS<br/>(hospital information systems)"]
        S2["LIS/PACS<br/>(lab/imaging systems)"]
        S3["PHR/wearables<br/>(personal health records)"]
    end

    subgraph FHIR_SRV["FHIR Server"]
        direction TB
        F1["FHIR Repository<br/>standard resource storage"]
        F2["FHIR API<br/>RESTful interface"]
    end

    subgraph APP["Application Services"]
        direction TB
        A1["AI diagnostic support,<br/>clinical decision-making"]
        A2["PHR app —<br/>patient self-access"]
        A3["Public health analytics,<br/>epidemiological investigation"]
    end

    SRC --> FHIR_SRV --> APP

    style SRC      fill:#E3F2FD,stroke:#1976D2,color:#1E3A5F
    style FHIR_SRV fill:#1E3A5F,stroke:#1E3A5F,color:#fff
    style APP      fill:#E8F5E9,stroke:#388E3C,color:#1B5E20
  

FHIR Adoption in Korea’s Digital Healthcare Sector

AreaApplicationRelated Agency / Regulation
My HealthwayPlatform for individuals to view and use their own health dataMinistry of Health and Welfare, National Health Insurance Service
Clinical information exchangeSharing treatment history between institutions based on patient consentMedical Service Act, clinical information exchange programs
AI medical devicesTraining/inference of AI models on FHIR-based clinical dataMinistry of Food and Drug Safety (MFDS) SaMD guidelines
Public healthLinking epidemiological data for legally notifiable diseases such as COVID-19Korea Disease Control and Prevention Agency (KDCA)

3. Expected Benefits and Application of HL7/FHIR Adoption

CategoryKey Expected BenefitsApplication and Practical Approach
InteroperabilityStandard data exchange between heterogeneous medical systemsBuild a FHIR-API-based hub connecting EMR, LIS, and PACS
Patient-centerednessPatients can view and move their own medical records directlyUse personal health data via My Healthway/PHR app integration
AI and analytics foundationStandardized clinical data improves AI model qualityBuild a clinical-data pipeline based on FHIR resources
Regulatory responseEstablishes a foundation for complying with domestic and international digital-health regulationsBuild a medical-app security certification framework based on SMART on FHIR