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About this Series This is the sixth and last article in a series on the dramatic transformation taking place in health informatics in large part because of the new Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) standard. The first article provided background on health care, electronic health record systems for physicians, and the challenges they both face along with the potential of interoperability to help overcome them. The second introduced the basics of the FHIR standard and some suggested resources for those who are interested in its further exploration. The third introduced SMART on FHIR which, based on its wide adoption, has become the default standard FHIR app platform. The fourth looked at clinical decision support, arguably the single most important provider-facing use case for FHIR. The fifth introduced the personal health record and tools that can utilize the data stored in it as an important use case for FHIR in support of patients. This article looks at the future uses of FHIR with a particular emphasis on those that might impact on research uses of health data. The articles in this series are intended to introduce researchers from other fields to this one and assume no prior knowledge of healthcare or health informatics. They are abstracted from the author's recently published book, Health Informatics on FHIR: How HL7's New API is Transforming Healthcare (Springer International Publishing: https://www.springer.com/us/book/9783319934136).

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About this series This is the fifth in a series of articles on the dramatic transformation taking place in health informatics in large part because of the new Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) standard. The first article provided background on health care, electronic health record systems for physicians, and the challenges they both face along with the potential of interoperability to help overcome them. The second introduced the basics of the FHIR standard and some suggested resources for those who are interested in its further exploration. The third introduced SMART on FHIR which, based on its wide adoption, has become the default standard FHIR app platform. The fourth looked at clinical decision support, arguably the single most important provider-facing use case for FHIR. This article introduces the personal health record and tools that can utilize the data stored in it as an important use case for FHIR in support of patients. The articles in this series are intended to introduce researchers from other fields to this one and assume no prior knowledge of health care or health informatics. They are abstracted from the author's recently published book, Health Informatics on FHIR: How HL7's New API is Transforming Healthcare (Springer International Publishing: https://www.springer.com/us/book/9783319934136).

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About this series This is the fourth in a series of articles on the dramatic transformation taking place in health informatics in large part because of the new Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) standard. The first article provided background on healthcare, electronic health record systems for physicians, and the challenges they both face along with the potential of interoperability to help overcome them. The second introduced the basics of the FHIR standard and some suggested resources for those who are interested in its further exploration. The third introduced SMART on FHIR, which, based on its wide adoption, has become the default standard FHIR app platform. This article introduces clinical decision support as an important use case for FHIR in support of health care providers. The articles in this series are intended to introduce researchers from other fields to this one and assume no prior knowledge of health care or health informatics. They are abstracted from the author's recently published book, Health Informatics on FHIR: How HL7's New API is Transforming Healthcare (Springer International Publishing: https://www.springer.com/us/book/9783319934136).

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About this series This is the third in a series of articles on the dramatic transformation taking place in health informatics in large part because of the new Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) standard. The first article provided the background on healthcare, electronic health record systems for physicians, and the challenges they both face along with the potential of interoperability to help overcome them. The second introduced the basics of the FHIR standard and some suggested resources for those who are interested in its further exploration. In this article, we explore SMART on FHIR which has become the default standard FHIR app platform based on its wide adoption. The articles in this series are intended to introduce researchers from other fields to this one and assume no prior knowledge of healthcare or health informatics. They are abstracted from the author's recently published book, Health Informatics on FHIR: How HL7's New API Is Transforming Healthcare (Springer International Publishing: https://www.springer.com/us/book/9783319934136).

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HL7 International's Fast Healthcare Interoperability Resources (FHIR) standard provides a common format for sharing health data (eg, FHIR resources) and a RESTful Application Programming Interface (eg, FHIR API) for accessing those resources via a FHIR server connected to an electronic health record system or any other system storing clinical data. Substitutable Medical Applications and Reusable Technologies (SMART) leverages FHIR to create an electronic health record (EHR) agnostic app platform. It utilizes the OAuth standard to provide for authorization and authentication. This paper describes the development and informal evaluation of Case Based Learning on FHIR (CBL on FHIR), a prototype EHR-connected FHIR/SMART platform to provide interactive digital cases for use in medical education. The project goals were to provide a more interactive form of CBL than is possible on paper to more realistically simulate clinical decision making and to expose medical students to modern informatics systems and tools for use in patient care.

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The first article of this series (see "About This Series") mentioned that, after the success of its new messaging standard for electronic health record (EHR) systems, Health Level 7 (HL7) found it difficult to develop and widely deploy a standard for the rich representation of clinical data for use in patient care. This was due, in large part, to the complexity of medicine and the resulting complexity of the clinical terminologies developed to represent it.

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It is hard to conceive of a better rationale for healthcare interoperability than the management of chronic disease. People in advanced, industrialized countries are living longer, and chronic disease rates among the elderly are on the rise in part because of lifestyle issues, such as obesity and inadequate exercise. As a result, the care of chronic diseases (such as hypertension, heart disease, diabetes, chronic lung disease, and chronic kidney disease) accounts for well over 90% of spending by Medicare, the U.S. health insurance program for people age 65 and over. The Agency for Healthcare Research and Quality has found that the top 5% of patients with four or more chronic diseases are responsible for 30% of all Medicare chronic disease spending. While just 17% of Medicare patients live with more than six chronic conditions, they account for half of all spending on beneficiaries with chronic disease.

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Health care delivery processes consist of complex activity sequences spanning organizational, spatial, and temporal boundaries. Care is human-directed so these processes can have wide variations in cost, quality, and outcome making systemic care process analysis, conformance testing, and improvement challenging. We designed and developed an interactive visual analytic process exploration and discovery tool and used it to explore clinical data from 5784 pediatric asthma emergency department patients.

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With greater pressures of providing high-quality care at lower cost due to a changing financial and policy environment, the ability to understand variations in care delivery and associated outcomes and act upon this understanding is of critical importance. Building on prior work in visualizing health-care event sequences and in collaboration with our clinical partner, we describe our process in developing a multiple, coordinated visualization system that helps identify and analyze care processes and their conformance to existing care guidelines. We demonstrate our system using data of 5,784 pediatric emergency department visits over a 13-month period for which asthma was the primary diagnosis.

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