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Uncovering Harmonization Potential in Health Care Data Through Iterative Refinement of Fast Healthcare
Lorenz Rosenau1, Paul Behrend1, Joshua Wiedekopf1
1IT Center for Clinical Research, University of Lübeck, Lübeck, Germany.
JMIR Medical Informatics
|July 23, 2024
Summary
This study refined Fast Healthcare Interoperability Resources (FHIR) profiles for German medical research data, improving cross-institutional interoperability. Harmonizing instance data and enhancing FHIR profiles are key to addressing discrepancies and enabling federated data access.
Area of Science:
- Medical Informatics
- Health Data Interoperability
- Clinical Data Standardization
Background:
- Cross-institutional interoperability in healthcare is a global challenge.
- The German Medical Informatics Initiative (MII) uses Fast Healthcare Interoperability Resources (FHIR) profiles for data exchange.
- The Core Data Set (CDS) and its extensions facilitate standardized health record representation across 37 German university hospitals.
Purpose of the Study:
- To evaluate a novel approach combining top-down FHIR profiles with bottom-up instance data analysis.
- To derive options for iterative FHIR profile refinement based on discrepancy analysis.
- To improve the specificity of FHIR profiles for medical research data querying.
Main Methods:
- Development of an FHIR validation pipeline.
- Derivation of more restrictive FHIR profiles from original CDS profiles.
- Analysis of discrepancies between clinical site instance data and feasibility platform profiles.
Main Results:
- 20 university hospitals participated in the study.
- Discrepancies were attributed to historical factors, lack of harmonization, diverse source systems, and coding case sensitivity.
- Laboratory values presented a significant harmonization challenge due to interdependencies between coding and value.
Conclusions:
- While CDS enables interoperability, federated data access requires more specific FHIR profiles.
- Harmonization of instance data can reduce retrospective harmonization efforts.
- Resolving discrepancies necessitates multi-level stakeholder action beyond clinical sites.
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