The challenges in the integration of healthcare applications: Using openEHR and FHIR standards

Abstract

Many healthcare applications need to communicate patient data. Transcribing data from one application to another is not acceptable since it may result in medication errors which can endanger the lives of patients. The data needs to be transferred from one application to another automatically. In order to integrate applications, syntactic and semantic interoperability is crucial. We present an integration of two healthcare applications in an
English hospital. The NHS in England has a requirement that healthcare applications must be integrated with a standard called FHIR. The use of the standard ensures syntactic interoperability. In order to achieve semantic interoperability, the translation from openEHR to FHIR must be performed in such a way that the context of data is preserved. Our paper has two objectives. The first is the transformation of data elements (fields) from the openEHR to the FHIR standard. The second is the identification of challenges that healthcare providers
need to be prepared for when using FHIR. We presented an English community called INTEROPen that manages the use of the CareConnect FHIR extended standard for integrating healthcare applications in England. Furthermore, we identified practical challenges of using CareConnect FHIR. The crucial challenge is related to transcribing patient data from the openEHR standard to the CareConnect FHIR standard. Such transcriptions can compromise a patient’s safety due to potential transcription errors. Another challenge is the interpretation of FHIR fields, which is possible in several ways. Also, new releases of FHIR, CareConnect FHIR and external dictionaries pose a challenge since they require the prompt and careful overhaul of applications. Vendors of healthcare application need to collaborate in order to implement changes in integrated applications in a
synchronized manner, to foresee the potential errors and, consequently, prepare strategies to mitigate them.