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BACKGROUND In the era of the digital economy, the demand for medical and public health services has soared in recent years, asking for developing innovative healthcare service models. This trend has accelerated the urgency to implement effective and efficient data exchange and service interoperability, which enable coordinated care services among tiered healthcare institutions, improve the quality of oversight of regulators, and provide vast and comprehensive data collection to support clinical medicine and health economics research, thus improving the overall service quality and patient satisfaction. However, the isolated data islands among heterogeneous IT systems have been a significant problem, seriously restricting data sharing and service interoperability capabilities. In this context, HL7 FHIR was formally introduced in 2014 and has since continued evolving. Because of its many advantages, such as a simple data model, flexible exchanging model, and adequate open source tools, this standard has attracted worldwide attention in the healthcare industry and has been adopted and promoted by health systems in the UK, USA, and Canada. OBJECTIVE By investigating and analyzing the latest literature on FHIR from the perspectives of motivations, techniques, and applications, we proposed a general FHIR Practice Guideline (FHIR PG) to facilitate stakeholders in the healthcare ecosystem to both understand the FHIR standard and build interoperable services with ease. METHODS We identified 487 papers from the Web of Science and IEEE databases and selected 85 papers published between January 1, 2020, and July 1, 2022, as the source of investigation. First, we chose to classify these papers into three categories: data standardization, data management, and data interoperation, for each of which we discussed the motivations, techniques, and applications. Then, we proposed a general FHIR PG for the entire FHIR practice process through careful analysis and collation. RESULTS The general FHIR PG clarified the unique roles of all the stakeholders involved, including the Implementation Guides (IGs) standard committee, healthcare IT system vendor, and application developer. And it integrated the data standardization flow, data exchange model, and service implementation approach into a complete practice process. As a result, the general FHIR PG facilitates stakeholders to practice the FHIR standard and design interoperable healthcare services. CONCLUSIONS This paper proposed a general FHIR PG by discussing the process of data standardization, data management, and data interoperation from the latest literature. The general FHIR PG can help a stakeholder in the healthcare ecosystem to identify its unique roles, manage the scope of responsibilities, and plan the work content, thereby facilitating the implementation and promotion of the FHIR standard.

Background With the advent of the digital economy and the aging population, the demand for diversified health care services and innovative care delivery models has been overwhelming. This trend has accelerated the urgency to implement effective and efficient data exchange and service interoperability, which underpins coordinated care services among tiered health care institutions, improves the quality of oversight of regulators, and provides vast and comprehensive data collection to support clinical medicine and health economics research, thus improving the overall service quality and patient satisfaction. To meet this demand and facilitate the interoperability of IT systems of stakeholders, after years of preparation, Health Level 7 formally introduced, in 2014, the Fast Healthcare Interoperability Resources (FHIR) standard. It has since continued to evolve. FHIR depends on the Implementation Guide (IG) to ensure feasibility and consistency while developing an interoperable health care service. The IG defines rules with associated documentation on how FHIR resources are used to tackle a particular problem. However, a gap remains between IGs and the process of building actual services because IGs are rules without specifying concrete methods, procedures, or tools. Thus, stakeholders may feel it nontrivial to participate in the ecosystem, giving rise to the need for a more actionable practice guideline (PG) for promoting FHIR’s fast adoption. Objective This study aimed to propose a general FHIR PG to facilitate stakeholders in the health care ecosystem to understand FHIR and quickly develop interoperable health care services. Methods We selected a collection of FHIR-related papers about the latest studies or use cases on designing and building FHIR-based interoperable health care services and tagged each use case as belonging to 1 of the 3 dominant innovation feature groups that are also associated with practice stages, that is, data standardization, data management, and data integration. Next, we reviewed each group’s detailed process and key techniques to build respective care services and collate a complete FHIR PG. Finally, as an example, we arbitrarily selected a use case outside the scope of the reviewed papers and mapped it back to the FHIR PG to demonstrate the effectiveness and generalizability of the PG. Results The FHIR PG includes 2 core elements: one is a practice design that defines the responsibilities of stakeholders and outlines the complete procedure from data to services, and the other is a development architecture for practice design, which lists the available tools for each practice step and provides direct and actionable recommendations. Conclusions The FHIR PG can bridge the gap between IGs and the process of building actual services by proposing actionable methods, procedures, and tools. It assists stakeholders in identifying participants’ roles, managing the scope of responsibilities, and developing relevant modules, thus helping promote FHIR-based interoperable health care services.