Chapter 9

📖 The F.H.I.R. Acronym

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What is an acronym?

An acronym is a word formed by taking the initial letters of a series of words or phrases and combining them into a single term. The letters typically represent the key words in the phrase, and the resulting acronym is often easier to say or remember than the full phrase.

For example:

  • NASA: National Aeronautics and Space Administration
  • RADAR: Radio Detection and Ranging
  • LASER: Light Amplification by Stimulated Emission of Radiation

Acronyms are commonly used to simplify complex terms, making them more manageable in conversation and writing. They are particularly prevalent in technical fields, organizations, and government agencies.

Some acronyms become so widely used that they are recognized as words in their own right (like “laser or “scuba”), while others are used more as shorthand in specific contexts.

FHIR stands for Fast Healthcare Interoperability Resources. From this acronym we get several more hints about its nature than just it being a standard, with all implications that come with that.

FHIR claims to be FAST

The meaning of FAST in this context is that FHIR is fast to implement.

To implement something refers to the process of putting a plan into effect. It involves taking the steps that are necessary to carry out the project in a practical, real-world setting.

FHIR is fast to implement because it uses modern web standards like Restful APIs, JSON and XML. Developers are already familiar with them because of they are widespread used all industries. Also, the docs are user friendly and focus on helping with implementation.

FHIR being fast can also apply to performance. The architecture of FHIR is built to handle high volumes of data and transactions, enabling swift access and retrieval of healthcare information.

FHIR is Healthcare-specific

FHIR is tailored for the healthcare industry.

Interoperability

The term interoperability appears to have originated within the context of the military and defense industry in the mid 20th century. It was used to describe the ability of different weapons systems, units or forces to work together effectively.

By the 1970s and 1980s, interoperability had become a common term in IT and telecommunications.

In healthcare, it means that doctors, nurses, hospitals, apps, pharmacies all can exchange and understand each other's medical records even if they use different types of computer systems. This helps everyone work together to improve healthcare for their patients.

In the introduction for non-developers we already mentioned some every-day examples for (missing) interoperability like different units for temperature and distance, or incompatibility of a Microsoft Office Presentation in Libre Office impress.

These everyday examples illustrate how lack of interoperability can lead to confusion and errors. But when it comes to more critical fields like aerospace, healthcare, or defense, the consequences of poor interoperability can be far more severe.

Incompatibility Examples

Real historical examples show that lacking interoperability, whether due to incompatible units, software errors, or outdated standards, can have dramatic and sometimes deadly consequences - expand the paragraph to learn more.

Interoperability issues can lead to serious and even catastrophic consequences. To illustrate the importance of consistent and standardized data across systems, here are five historical examples where a lack of interoperability resulted in major failures:

1. Mars Climate Orbiter

In 1999, NASA’s Mars Climate Orbiter was lost in space due to a simple unit conversion error. One team used metric units (newtons), while another used imperial units (pounds-force) for the spacecraft’s navigation software. The lack of standardization led to the spacecraft deviating from its intended path and burning up in Mars’ atmosphere. A failure to ensure data compatibility resulted in a $125 million mission loss.

2. Therac-25 Radiation Therapy Machine

The Therac-25 was a radiation therapy machine that, in the 1980s, caused severe radiation overdoses due to a software error. The lack of proper interoperability and communication between software modules led to malfunctions in the machine’s safety systems. This resulted in the machine delivering radiation doses hundreds of times higher than intended, causing serious injuries and deaths.

3. Airbus A400M

In 2015, an Airbus A400M military transport aircraft crashed during a test flight, killing four crew members. The accident was traced back to software configuration issues that caused the engines to shut down unexpectedly. Different teams used incompatible software formats that were not properly integrated, leading to a critical failure in the aircraft’s control systems.

4. Patriot Missile Failure in the 1991 Gulf War

During the 1991 Gulf War, a Patriot missile defense system failed to intercept a Scud missile, resulting in the deaths of 28 American soldiers. The failure was due to a software bug caused by a timing error that arose from incompatibility between the system’s internal clock and the actual passage of time. The system was off by 0.34 seconds, enough to miss the target by hundreds of meters.

5. Year 2000 Problem (Y2K Bug)

The Y2K bug was a computer flaw that resulted from the practice of using two-digit numbers to represent years (e.g., “99” for 1999). As the year 2000 approached, there were fears that systems would interpret “00” as 1900, causing widespread software failures. The issue highlighted the need for consistent data standards and proper planning for long-term interoperability in computer systems.

Resources

The central role of FHIR is played by resources. They are predefined data structures that represent different healthcare entities.

Examples are:

For each resource, specific properties are defined. For example, a patient has a name, an address, an identifier, a birthdate, a gender and other characteristics.

These properties are like fields in a form that can be filled with the patient’s data. But unlike a paper form, a patient resource provides more flexibility and mechanisms to check if the data is correct or missing. Moreover, it is readable and understandable by a computer.

All information that is exchanged is packaged in a FHIR resource.

Patient data, medication data, terminologies, even technical info like the capability statement of a server that says what it can offer, are resources.

You can imagine as separate paper forms for different aspects of health care.

You will learn more about Resources in this learning unit.