FHIR® - Fast Healthcare Interoperability Resources®

Fast Healthcare Interoperability Resources® (FHIR®) Measure Tooling and Resources

FHIR® Implementation Guides (IGs)

IGs provide detailed instructions for implementing FHIR standards for specific healthcare use cases. They define how FHIR resources, profiles, terminology, and conformance requirements should be used so healthcare systems can exchange information consistently and interoperable. The following implementation guides support the development, implementation, reporting, and exchange of digital quality measures (dQMs).

• FHIR® Implementation Guide Registry: The FHIR® IG Registry is a centralized catalog of Health Level Seven International® (HL7®) FHIR implementation guides. It allows users to search, browse, and access published and ballot version of the IGs developed by HL7® and other organizations. The registry has services for locating FHIR implementation guidance with a wide range of health interoperability use cases. 
• FHIR® Quality Measure (QM) Implementation Guide (IG): The FHIR® QM IG provides guidance for representing dQMs using the FHIR® Measure resource, the FHIR Clinical Reasoning Module, Quality Improvement (QI)-Core IG/US Quality Core IG, and Clinical Quality Language (CQL). It defines structure, metadata, populations, terminology and expression logic needed to author, exchange and evaluate dQMs. 

• Data Exchange for Quality Measures Implementation Guide (DEQM IG): The HL7® DEQM IG defines how systems can exchange dQM information using FHIR. It supports the electronic exchange of quality measurement data and results between healthcare providers, payers, public health agencies, and other organizations. 

  The DEQM IG support several reporting scenarios, including: 

  • Individual patient
  • Subject list reporting
  • Summary (aggregate) reporting
  • Gaps in care reporting

  The DEQM Individual MeasureReport profile provides a FHIR-based approach for patient-level quality reporting and serves a similar purpose as Quality Reporting Document Architecture (QRDA) Category I. The DEQM Summary MeasureReport profile provides a FHIR-based approach for aggregate reporting and serves a similar purpose as QRDA Category III.

• Quality Improvement Core (QI-Core) IG: This IG provides the FHIR-based clinical data model used for dQMs and clinical decision support (CDS). Built on US-Core IG, QI-Core defines profiles that constrain FHIR resources to support consistent representation of clinical data used in quality measurement, dQM development, and CDS authoring. The aim for QI-Core is to replace QDM as the data model for dQMs.

FHIR® Testing Tools

A variety of tools are available to help developers learn, implement, test, and validate dQMs. These tools support activities such as FHIR resource validation, application programming interface (API) testing, CQL execution, interoperability testing, and synthetic data generation.

• ClinFHIR®: An open-source tool that provides an educational environment and also allows developers to create or search for FHIR-based resources. This tool helps people learn about FHIR® by visualizing how the parts combine to represent clinical information in a structured and coded manner. It also serves as a development tool with features to build and validate some of the required artifacts, particularly as an aid to learning.
• FHIR® Servers - Public Testing Servers: HL7® provides a list of FHIR® servers publicly available for testing. These are public services provided by volunteers and HL7® makes no representations concerning their safety or reliability.
• Postman: A collaboration platform designed for developing and testing application programming interfaces (APIs). Postman simplifies interactions with FHIR® servers, enabling users to post requests and updates efficiently. It is particularly useful for testing FHIR-based dQMs during Health Level Seven International® Connectathons.
• CQL Runner: An online platform for ad hoc testing of CQL.
• Inferno: Inferno is an open-source tool for creating, executing, and sharing automated FHIR® conformance tests. Hosted on HealthIT.gov, it offers public services for running select tests, including those for the ONC Health IT Certification Program, and provides flexible tools for local and integrated testing.

Test Data Tools

• Synthea^TM: An open-source repository that enables the generation of realistic but synthetic patient data and health records, covering every aspect of health care. The resulting data is free from cost, privacy, and security restrictions, enabling research with health information technology data that is otherwise legally or practically unavailable.
  • Browse and download synthetic records
• HL7® Downloads: HL7® webpage that contains examples, reference implementations, and other useful resources.