What Is FHIR?
FHIR (Fast Healthcare Interoperability Resources) is an HL7 standard for exchanging healthcare information using modern web technologies (RESTful APIs, JSON/XML, OAuth 2.0), used for clinical data exchange, patient access APIs, and increasingly for prior-authorization and quality reporting.
- Practices using ONC-certified EHRs already have FHIR APIs available (EHR vendor configures the endpoint and OAuth setup).
- Use cases for billing teams: querying coverage details from payer Patient Access APIs, retrieving past claim history, and supporting digital quality measures (eCQMs) reporting.
FHIR
Also known as: Fast Healthcare Interoperability Resources; HL7 FHIR
FHIR (Fast Healthcare Interoperability Resources) is an HL7 standard for exchanging healthcare information using modern web technologies (RESTful APIs, JSON/XML, OAuth 2.0), used for clinical data exchange, patient access APIs, and increasingly for prior-authorization and quality reporting.
Definition
Developed by HL7, FHIR R4 is the current normative version, with R5 published. FHIR uses 'resources' (Patient, Encounter, Observation, MedicationRequest, Claim, Coverage, etc.) exchanged via REST APIs over HTTPS, secured by OAuth 2.0/SMART on FHIR. The ONC Cures Act Final Rule mandates FHIR-based patient access APIs and bulk data export for ONC-certified EHRs. CMS rules (Patient Access API, Provider Directory API, Payer-to-Payer API) require payers to expose FHIR APIs. Da Vinci Project implementation guides extend FHIR for prior auth (PAS, CRD, DTR), value-based care, and quality reporting.
Example
A patient's iPhone Health app uses SMART on FHIR with OAuth 2.0 to authenticate to their provider's EHR FHIR API and pull Patient, Observation (vital signs, labs), MedicationStatement, and Condition resources into the app. Payers expose Coverage and ExplanationOfBenefit resources via Patient Access APIs.
Common Misconceptions
FHIR is not replacing X12 for claims billing — at least not soon. CMS has piloted FHIR-based prior authorization (Da Vinci PAS) and continues to expand Patient Access APIs, but the 837 X12 transaction remains the production standard for claim submission. FHIR augments rather than replaces X12 in administrative workflows.
Practical Application
Practices using ONC-certified EHRs already have FHIR APIs available (EHR vendor configures the endpoint and OAuth setup). Use cases for billing teams: querying coverage details from payer Patient Access APIs, retrieving past claim history, and supporting digital quality measures (eCQMs) reporting.
Related Terms
EHR (Electronic Health Record)
An Electronic Health Record is a digital, longitudinal record of a patient's health information maintained by a healthcare organization, designed to be shared across providers and care settings, and to support clinical decisions, billing, and quality reporting.
Read definition arrow_forward21st Century Cures Act
The 21st Century Cures Act is a 2016 federal law that, among many other provisions, established information blocking prohibitions and patient access requirements for electronic health information, enforced under the ONC Cures Act Final Rule.
Read definition arrow_forwardInformation Blocking Rule
The Information Blocking Rule, codified at 45 CFR Part 171 under the 21st Century Cures Act, prohibits health care providers, health IT developers, and health information networks from engaging in practices likely to interfere with access, exchange, or use of electronic health information (EHI), subject to eight regulatory exceptions.
Read definition arrow_forwardWhere This Applies on MedPrecision
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