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. 2023 Oct 19;30(11):1858-1864.
doi: 10.1093/jamia/ocad131.

FHIR-up! Advancing knowledge from clinical data through application of standardized nursing terminologies within HL7® FHIR®

Karen A Monsen  1 , Laura Heermann  2   3 , Karen Dunn-Lopez  4
Affiliations

FHIR-up! Advancing knowledge from clinical data through application of standardized nursing terminologies within HL7® FHIR®

Karen A Monsen et al. J Am Med Inform Assoc. .

Abstract

Health Level 7®'s (HL7) Fast Healthcare Interoperability Resources® (FHIR®) is leading new efforts to make data available to healthcare clinicians, administrators, and leaders. Standardized nursing terminologies were developed to enable nursing's voice and perspective to be visible within the healthcare data ecosystem. The use of these SNTs has been shown to improve care quality and outcomes, and to provide data for knowledge discovery. The role of SNTs in describing assessments and interventions and measuring outcomes is unique in health care, and synergistic with the purpose and goals of FHIR. FHIR acknowledges nursing as a discipline of interest and yet the use of SNTs within the FHIR ecosystem is rare. The purpose of this article is to describe FHIR, SNTs, and the potential for synergy in the use of SNTs with FHIR. Toward improving understanding how FHIR works to transport and store knowledge and how SNTs work to convey meaning, we provide a framework and examples of SNTs and their coding for use within FHIR solutions. Finally, we offer recommendations for the next steps to advance FHIR-SNT collaboration. Such collaboration will advance both nursing specifically and health care in general, and most importantly, improve population health.

Keywords: HL7 FHIR; clinical guidelines; interoperability; outcomes; quality; standardized nursing terminologies.

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Conflict of interest statement

None declared.

Figures

Figure 1.
Figure 1.
Conceptual framework for embedding standardized nursing terminologies within HL7 FHIR profiles and resources. In this original framework, we depict the packaging of diverse reusable items. The outer structure depicts packaging comprised of FHIR Resources which package data for exchange or storage; as defined by APIs, or codes that specify how healthcare information can be communicated. Within this packaging, we depict FHIR profiles as hexagonal shapes which specify transmission or storage of resource/API content in specific circumstances. Within FHIR profiles are shapes depicting standardized nursing terminology data. Note that resources and profiles can also store or transmit unstandardized content such as free text, potentially losing data integrity. API: application programming interface; FHIR: fast healthcare interoperability resources.
Figure 2.
Figure 2.
Signs/symptoms of the Communication with community resources problem. Codes are provided for SNOMED CT concept ID and the Omaha System (in parentheses).
Figure 3.
Figure 3.
The enhanced recovery after surgery hip and knee replacement recovery guideline. Codes are provided for SNOMED CT concept ID and the Omaha System (in parentheses). Interventions address 10 problems. They are shown as linked category-target-care description terms, followed by coding. Within SNOMED CT, each category-target combination has a single SNOMED CT code.
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