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In today’s environment, FHIR integration is typically point-to-point without the need for routing information. In this model, it is usually known who the requestor and responder are without the need for multi-hop routing data. As FHIR scales and the number of actors grow, a hybrid environment will exist where dynamic point to point as well as intermediary or multi-intermediary models (e.g., clearinghouses, HIEs, national networks, and other exchanges) are being used, and routing information will become more important.
As the need for integration between different actors in healthcare has grown, transaction routing across one or more intermediaries is recognized as a key aspect of reliable exchange. One example scenario is when a payer uses a clearinghouse intermediary as their 'gateway' for transactions. There are both technical and business operational value-adds in this intermediary model, and it is expected to continue in the evolving RESTful FHIR API integration model. Other networks including HIEs and national networks, have emerged as brokering intermediaries (document access/exchange, e-prescribing, etc.), that may also engage in FHIR based interoperability. In the model described above, the interaction originator will know the final destination but will not need to be concerned with whether intermediaries are involved in the message routing. The intermediary, or intermediaries, will need to have origination and routing information available during the life cycle of the transaction to ensure appropriate delivery. The recommended solution leverages existing internet name server and routing mechanisms to enable reliable exchange regardless of whether the transaction is dynamic point-to-point or via intermediaries.
The following illustration includes an intermediary since the solution must operate in a hybrid model of point-to-point exchange or exchanging through intermediaries. The solution is depicted in a relatively simple transaction. The requestor actor could be a payer, provider or other stakeholder.
The originator of the transaction in step one addresses the exchange to the destination's public FHIR service URL which resolves to an intermediary. The intermediary in the next step forwards the exchange using the destination's private routing information (shared through its arrangement with the destination). The destination responds to the request and either references its public FHIR address in returned resources, or depends on its intermediary partner to ensure they are consistent with the public address used by the originator. One or more intermediaries may be involved in routing the transaction, but the originator need only be concerned with identifying the final destination.
|February 18, 2021|
|June 10, 2021|
Implementation Guide development is taking place through the HL7 FHIR Infrastructure workgroup. Working sessions take place twice monthly on the 1st and 3rd Tuesdays at 1pm ET, and the team will be meeting weekly starting August 17th until the September Connectathon:
- Call details:
United States: +1 (872) 240-3412
- One-touch: tel:+18722403412,,262996117#
Access Code: 262-996-117
Industry Feedback Sessions
- FAST Exchange Tiger Team TLC Webinar
- FAST HL7 FHIR Standard Based Solution for Intermediary-to-Intermediary Exchange - Expert Panel Discussion
HL7 Ballot Cycle: Jan 2022 - STU
HL7 Project Page: FHIR at Scale (FAST): Exchange with or without Intermediaries
Sponsoring Workgroup: FHIR Infrastructure
- FHIR-I Workgroup meets on Mondays, 3-4pm ET
- Hybrid/Intermediary Exchange team meets twice monthly on 1st and 3rd Tuesdays at 1pm ET
HL7 Project Artifacts:
- Project Proposal
- Project Scope Statement (PSS)
- FHIR IG Proposal
- Notice of Intent to Ballot (NIB)
- HL7 IG Reliable Routing Over Intermediaries_DRAFT_122120.docx
- Hybrid/Intermediary Exchange Implementation Guide DRAFT (Continuous Integration Build)
- 2021-01 FHIR at Scale (FAST): Exchange with or without Intermediaries
- 2021-05 Hybrid/Intermediary Exchange (Exchange with or without Intermediaries)
- CMS2021-07 ONC FAST Exchange
- 2021-09 ONC FAST - Hybrid/Intermediary Exchange