Clinical, technical, and implementation characteristics of real-world health applications using FHIR

OBJECTIVE: Understanding the current state of real-world Fast Healthcare Interoperability Resources (FHIR) applications (apps) will benefit biomedical research and clinical care and facilitate advancement of the standard. This study aimed to provide a preliminary assessment of these apps’ clinical, technical, and implementation characteristics. MATERIALS AND METHODS: We searched public repositories for potentially eligible FHIR apps and surveyed app implementers and other stakeholders. RESULTS: Of the 112 apps surveyed, most focused on clinical care (74) or research (45); were implemented across multiple sites (56); and used SMART-on-FHIR (55) and FHIR version R4 (69). Apps were primarily stand-alone web-based (67) or electronic health record (EHR)-embedded (51), although 49 were not listed in an EHR app gallery. DISCUSSION: Though limited in scope, our results show FHIR apps encompass various domains and characteristics. CONCLUSION: As FHIR use expands, this study—one of the first to characterize FHIR apps at large—highlights the need for systematic, comprehensive methods to assess their characteristics.