FHIR in Healthcare: Navigating the Challenges of Adoption

By Eric Snyder, Executive Director, Technology & Innovation Group, The University of Rochester Medical Center, Wilmot Cancer Institute

The Fast Healthcare Interoperability Resources, commonly known as FHIR, is a recurring topic in healthcare technology discussions. Despite its introduction in 2012 and its potential to revolutionize data exchange, widespread adoption has been sluggish. The vast majority of data transfer within healthcare settings still relies on flat files and basic HL7 messaging standards.

Undoubtedly, foundational interoperability structures are essential to healthcare’s technical advancement, and FHIR could be a part of that answer. However, the limited adoption rate indicates underlying issues that need to be addressed if FHIR is to fulfill its promise. Something fundamental needs to change.

We need tools, platforms, and education that demystify FHIR, allowing healthcare organizations to leverage their existing talent rather than rely on external consultants and vendors.

Understanding the Barriers to Adoption

We must first acknowledge some key barriers to understand why FHIR adoption is lagging.

1. Historical Hesitancy to Embrace New Technology: Healthcare has traditionally been slow to adopt new technologies. This conservative approach stems from several factors, including patient safety concerns, regulatory hurdles, and the complexity of the systems already in place. However, FHIR has been around for over a decade, so this alone doesn’t fully explain the current situation.
2. High Conversion Costs: Converting existing HL7 and other interfaces into an FHIR-based model can be prohibitively expensive, especially when existing systems are already functional. Healthcare organizations often face thin budgets and may not see the immediate value in investing heavily in new infrastructure when current interfaces are meeting their basic needs.
3. Complexity of FHIR: FHIR’s complexity poses significant challenges, particularly for internal healthcare teams. Historically, healthcare organizations relied heavily on vendors and consultants to manage complex IT integrations, and this model worked well for a time. However, with budget constraints and a growing need for internal teams to take the lead, this reliance is becoming unsustainable.

Why FHIR Feels Like a ‘Pain’ for Internal Teams

To understand why many internal teams find FHIR challenging, it helps to start by comparing it to its predecessor, HL7. Over the years, many in healthcare have become familiar with HL7, specifically HL7 v2, which is still widely used for data exchange. HL7 v2 is relatively straightforward and predictable; it organizes data into flat files with a defined structure and fixed fields. This simplicity allows many teams to work with it using basic programming knowledge or even manual tools. In contrast, FHIR introduces a much more detailed and complex structure with numerous rules and interdependencies.

FHIR uses a resource-based model where each type of data (like patients, medications, or observations) is represented as a separate “resource.” These resources have their own sets of elements, attributes, and rules. Each resource can reference other resources, creating complex webs of interdependencies that require more sophisticated management and understanding. Internal teams accustomed to the simplicity of HL7’s structure often find this overwhelming which leads to several pain points for internal teams, including:

1. Steep learning curve: FHIR requires a deeper understanding of its resource-based model, which can be challenging for teams without prior experience.
2. Increased development time: The complexity of FHIR requires more sophisticated development and testing, leading to longer development times and increased costs.
3. Interoperability challenges: FHIR’s resource-based model can create interoperability challenges, as different systems may interpret the same resource differently.
4. Data mapping and transformation: FHIR’s complex structure requires more extensive data mapping and transformation, which can be time-consuming and error-prone.

The Resulting Gap in Internal Expertise

Because of these complexities, effectively implementing FHIR often requires strong coding skills and a deep understanding of modern web technologies. Many internal healthcare teams, particularly in smaller organizations, do not have this level of expertise. They may rely on technical staff who are familiar with HL7 and other traditional healthcare standards but lack the experience or resources to work effectively with FHIR.

This gap is even more pronounced in organizations that cannot afford to hire specialized developers or continually depend on external vendors for FHIR implementation. As a result, FHIR can feel like a “pain” for these internal teams, who find themselves overwhelmed by its intricacies and ill-equipped to handle the shift without substantial investment in training and resources.

A Need for a Simpler Approach

The solution may not lie in abandoning FHIR altogether—there is a lot of thoughtful design in its framework, and it has the potential to significantly advance healthcare interoperability. However, there is a pressing need for a simpler, more accessible approach that reduces friction for internal teams.

One potential solution could be a “translation layer” that reliably translates data back and forth between FHIR and other formats, such as raw data. This intermediary layer would make it easier for healthcare teams to handle FHIR in much the same way they have adapted to other interoperability standards.

The Path Forward

For FHIR to see greater adoption, it needs to be made more accessible to internal teams. We need tools, platforms, and education that demystify FHIR, allowing healthcare organizations to leverage their existing talent rather than rely on external consultants and vendors. Only then can we fully realize the benefits that FHIR promises for interoperability, data exchange, and ultimately, patient care.

As we move forward, the industry must recognize that while FHIR itself is not inherently “bad,” its complexity and the current reliance on external expertise present significant hurdles. By simplifying the approach and providing internal teams with the tools and knowledge they need to manage FHIR effectively, we can begin to see wider adoption and a more seamless flow of healthcare data.