Solution Description

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.

Solution Status

February 18, 2021
  • Jan 2021 Connectathon Testing Complete
  • HL7 PSS Approved
  • HL7 FHIR IG Proposal Approved
  • Implementation Guide Development In Progress
June 10, 2021
  • Targeting Sept 2021 STU Ballot
  • May 2021 Connectathon Testing Complete
  • Planning to participate in CMS Connectathon in July 2021
  • Implementation Guide Development In Progress

Get Involved!

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

Join us to test during the HL7 September Connectathon!  For more details, check out the track page: 2021-09 ONC FAST - Hybrid/Intermediary Exchange

Solution Roadmap

Oct2020 Nov Dec Jan2021 Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan2022 Feb Mar Jan 2021 HL7 FHI… May 2021 HL7 FHI… HL7 May 2021 Ballot Cycle Sept 2021 HL7 FHI… HL7 Sept 2021 Ballot Cycle HL7 Jan 2022 Ballot Cycle
FAST Solution Documentation
Initiate Project with HL7
HL7 FHIR Connectathons
IG Development & Balloting

Complete V3 Solution Document

Submit PSS and Obtain Approvals

Submit FHIR IG Proposal and Obtain Approvals

Prepare for Jan 2021 Connectathon Testing

Prepare for May 2021 Connectathon

Prepare for Sept 2021 Connectathon

Implementation Guide Development

Jan STU Ballot

Ballot Reconciliation

Publish STU 1

Prepare for May 2022 STU 2 Ballot Cycle

Prepare for Jan 2022 STU 1 Ballot

Testing/Implementation Artifacts

Pilot Toolkit:

  • Coming in Q2/Q3 2021


  • Coming in Q2/Q3 2021

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