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64-447: The Fast Healthcare Interoperability Resources ( FHIR , / f aɪər / , like fire ) standard is a set of rules and specifications for exchanging electronic health care data. It is designed to be flexible and adaptable, so that it can be used in a wide range of settings and with different health care information systems. The goal of FHIR is to enable the seamless and secure exchange of health care information, so that patients can receive

128-544: A procedural language such as Lua could consist primarily of basic routines to execute code, manipulate data or handle errors while an API for an object-oriented language , such as Java, would provide a specification of classes and its class methods . Hyrum's law states that "With a sufficient number of users of an API, it does not matter what you promise in the contract: all observable behaviors of your system will be depended on by somebody." Meanwhile, several studies show that most applications that use an API tend to use

192-420: A software framework : a framework can be based on several libraries implementing several APIs, but unlike the normal use of an API, the access to the behavior built into the framework is mediated by extending its content with new classes plugged into the framework itself. Moreover, the overall program flow of control can be out of the control of the caller and in the framework's hands by inversion of control or

256-418: A user interface , which connects a computer to a person, an application programming interface connects computers or pieces of software to each other. It is not intended to be used directly by a person (the end user ) other than a computer programmer who is incorporating it into software. An API is often made up of different parts which act as tools or services that are available to the programmer. A program or

320-449: A broad term describing much of the communication on the internet. When used in this way, the term API has overlap in meaning with the term communication protocol . The interface to a software library is one type of API. The API describes and prescribes the "expected behavior" (a specification) while the library is an "actual implementation" of this set of rules. A single API can have multiple implementations (or none, being abstract) in

384-517: A business ecosystem. The main policies for releasing an API are: An important factor when an API becomes public is its "interface stability". Changes to the API—for example adding new parameters to a function call—could break compatibility with the clients that depend on that API. When parts of a publicly presented API are subject to change and thus not stable, such parts of a particular API should be documented explicitly as "unstable". For example, in

448-457: A client would need to know for practical purposes. Documentation is crucial for the development and maintenance of applications using the API. API documentation is traditionally found in documentation files but can also be found in social media such as blogs, forums, and Q&A websites. Traditional documentation files are often presented via a documentation system, such as Javadoc or Pydoc, that has

512-435: A consistent appearance and structure. However, the types of content included in the documentation differs from API to API. In the interest of clarity, API documentation may include a description of classes and methods in the API as well as "typical usage scenarios, code snippets, design rationales, performance discussions, and contracts", but implementation details of the API services themselves are usually omitted. It can take

576-588: A data store where they can be correlated with other informatics data. Potential use cases include epidemic tracking, prescription drug fraud, adverse drug interaction warnings, and the reduction of emergency room wait times. A number of high-profile players in the health care informatics field are showing interest in and experimenting with FHIR, including CommonWell Health Alliance and SMART (Substitutable Medical Applications, Reusable Technologies). Open source implementations of FHIR data structures, servers, clients and tools include reference implementations from HL7 in

640-524: A given API, it is possible to infer the typical usages, as well the required contracts and directives. Then, templates can be used to generate natural language from the mined data. In 2010, Oracle Corporation sued Google for having distributed a new implementation of Java embedded in the Android operating system. Google had not acquired any permission to reproduce the Java API, although permission had been given to

704-515: A joint activity of the Ministry and 8400, a number of projects were launched for the implementation of FHIR in health management organizations (HMO) and hospitals, alongside other projects that are being independently promoted by healthcare organizations. In addition, the Ministry of Health allocated budgets to the HMOs and other organizations for the purpose of establishing organizational FHIR infrastructure. In

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768-441: A modular software library in the 1940s for EDSAC , an early computer. The subroutines in this library were stored on punched paper tape organized in a filing cabinet . This cabinet also contained what Wilkes and Wheeler called a "library catalog" of notes about each subroutine and how to incorporate it into a program. Today, such a catalog would be called an API (or an API specification or API documentation) because it instructs

832-417: A new software product. The process of joining is called integration . As an example, consider a weather sensor that offers an API. When a certain message is transmitted to the sensor, it will detect the current weather conditions and reply with a weather report. The message that activates the sensor is an API call , and the weather report is an API response . A weather forecasting app might integrate with

896-470: A number of forms, including instructional documents, tutorials, and reference works. It'll also include a variety of information types, including guides and functionalities. Restrictions and limitations on how the API can be used are also covered by the documentation. For instance, documentation for an API function could note that its parameters cannot be null, that the function itself is not thread safe . Because API documentation tends to be comprehensive, it

960-414: A number of weather sensor APIs, gathering weather data from throughout a geographical area. An API is often compared to a contract . It represents an agreement between parties: a service provider who offers the API and the software developers who rely upon it. If the API remains stable, or if it changes only in predictable ways, developers' confidence in the API will increase. This may increase their use of

1024-440: A programmer on how to use (or "call") each subroutine that the programmer needs. Wilkes and Wheeler's book The Preparation of Programs for an Electronic Digital Computer contains the first published API specification. Joshua Bloch considers that Wilkes and Wheeler "latently invented" the API, because it is more of a concept that is discovered than invented. The term "application program interface" (without an -ing suffix)

1088-453: A programmer that uses one of these parts is said to call that portion of the API. The calls that make up the API are also known as subroutines , methods, requests, or endpoints . An API specification defines these calls, meaning that it explains how to use or implement them. One purpose of APIs is to hide the internal details of how a system works, exposing only those parts a programmer will find useful and keeping them consistent even if

1152-643: A shipping company API that can be added to an eCommerce-focused website to facilitate ordering shipping services and automatically include current shipping rates, without the site developer having to enter the shipper's rate table into a web database. While "web API" historically has been virtually synonymous with web service , the recent trend (so-called Web 2.0 ) has been moving away from Simple Object Access Protocol ( SOAP ) based web services and service-oriented architecture (SOA) towards more direct representational state transfer (REST) style web resources and resource-oriented architecture (ROA). Part of this trend

1216-404: A similar mechanism. An API can specify the interface between an application and the operating system . POSIX , for example, specifies a set of common APIs that aim to enable an application written for a POSIX conformant operating system to be compiled for another POSIX conformant operating system. Linux and Berkeley Software Distribution are examples of operating systems that implement

1280-441: A small part of the API. Language bindings are also APIs. By mapping the features and capabilities of one language to an interface implemented in another language, a language binding allows a library or service written in one language to be used when developing in another language. Tools such as SWIG and F2PY, a Fortran -to- Python interface generator, facilitate the creation of such interfaces. An API can also be related to

1344-463: A software system, used for machine-to-machine communication. A well-designed API exposes only objects or actions needed by software or software developers. It hides details that have no use. This abstraction simplifies programming. Building software using APIs has been compared to using building-block toys, such as Lego bricks. Software services or software libraries are analogous to the bricks; they may be joined together via their APIs, composing

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1408-488: A system of commands and thereby bar all others from writing its different versions to carry out all or part of the same commands. Clinical Document Architecture The HL7 Clinical Document Architecture ( CDA ) is an XML -based markup standard intended to specify the encoding, structure and semantics of clinical documents for exchange. In November 2000, HL7 published Release 1.0. The organization published Release 2.0 with its "2005 Normative Edition". CDA specifies

1472-521: A user's FHIR-compliant medical records when providers choose to make them available. Johns Hopkins Medicine, Cedars-Sinai, Penn Medicine, NYU-Langone Medical Center, Dignity Health and other large hospital systems participated at launch. In 2014, the U.S. Health IT Policy and the Health IT Standards committees endorsed recommendations for more public (open) APIs. The U.S. JASON task force report on "A Robust Health Data Infrastructure" says that FHIR

1536-614: A variety of languages, SMART on FHIR, HAPI-FHIR in Java, and many others (see reference). A variety of applications were demonstrated at the FHIR Applications Roundtable in July 2016. The Sync for Science (S4S) profile builds on FHIR to help medical research studies ask for (and if approved by the patient, receive) patient-level electronic health record data. In January, 2018, Apple announced that its iPhone Health App would allow viewing

1600-454: Is a challenge for writers to keep the documentation updated and for users to read it carefully, potentially yielding bugs. API documentation can be enriched with metadata information like Java annotations . This metadata can be used by the compiler, tools, and by the run-time environment to implement custom behaviors or custom handling. It is possible to generate API documentation in a data-driven manner. By observing many programs that use

1664-512: Is an architectural approach that revolves around providing a program interface to a set of services to different applications serving different types of consumers. When used in the context of web development , an API is typically defined as a set of specifications, such as Hypertext Transfer Protocol (HTTP) request messages, along with a definition of the structure of response messages, usually in an Extensible Markup Language ( XML ) or JavaScript Object Notation ( JSON ) format. An example might be

1728-576: Is certified by ANSI . CDA Release 2 has been adopted as an ISO standard, ISO / HL7 27932:2009. Australia's Personally Controlled Electronic Health Record (PCEHR), known as "My Health Record", uses a specialized implementation of HL7 CDA Release 2. In the UK the Interoperability Toolkit (ITK) utilises the "CDA R2 from HL7 V3 – for CDA profiles" for the Correspondence pack. In the U.S.

1792-516: Is created in one place dynamically can be posted and updated to multiple locations on the web. For example, Twitter's REST API allows developers to access core Twitter data and the Search API provides methods for developers to interact with Twitter Search and trends data. The design of an API has significant impact on its usage. The principle of information hiding describes the role of programming interfaces as enabling modular programming by hiding

1856-610: Is currently the best candidate API approach, and that such APIs should be part of stage 3 of the "meaningful use" criteria of the U.S. Health Information Technology for Economic and Clinical Health Act . In December 2014, a broad cross-section of US stakeholders committed to the Argonaut Project which will provide acceleration funding and political will to publish FHIR implementation guides and profiles for query/response interoperability and document retrieval by May 2015. It would then be possible for medical records systems to migrate from

1920-875: Is easier to implement because it uses a modern web-based suite of API technology, including a HTTP -based RESTful protocol, and a choice of JSON , XML or RDF for data representation. One of its goals is to facilitate interoperability between legacy health care systems, to make it easy to provide health care information to health care providers and individuals on a wide variety of devices from computers to tablets to cell phones, and to allow third-party application developers to provide medical applications which can be easily integrated into existing systems. FHIR provides an alternative to document-centric approaches by directly exposing discrete data elements as services. For example, basic elements of healthcare like patients, admissions, diagnostic reports and medications can each be retrieved and manipulated via their own resource URLs . FHIR

1984-399: Is first recorded in a paper called Data structures and techniques for remote computer graphics presented at an AFIPS conference in 1968. The authors of this paper use the term to describe the interaction of an application—a graphics program in this case—with the rest of the computer system. A consistent application interface (consisting of Fortran subroutine calls) was intended to free

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2048-453: Is now the most common meaning of the term API. The Semantic Web proposed by Tim Berners-Lee in 2001 included "semantic APIs" that recast the API as an open , distributed data interface rather than a software behavior interface. Proprietary interfaces and agents became more widespread than open ones, but the idea of the API as a data interface took hold. Because web APIs are widely used to exchange data of all kinds online, API has become

2112-722: Is organized by resources (e.g., patient, observation). Such resources can be specified further by defining FHIR profiles (for example, binding to a specific terminology). A collection of profiles can be published as an implementation guide (IG), such as The U.S. Core Data for Interoperability (USCDI). The ONC anticipates finalizing USCDI v4 in July 2023. Because FHIR is implemented on top of the HTTPS (HTTP Secure) protocol, FHIR resources can be retrieved and parsed by analytics platforms for real-time data gathering. In this concept, healthcare organizations would be able to gather real-time data from specified resource models. FHIR resources can be streamed to

2176-469: Is related to the Semantic Web movement toward Resource Description Framework (RDF), a concept to promote web-based ontology engineering technologies. Web APIs allow the combination of multiple APIs into new applications known as mashups . In the social media space, web APIs have allowed web communities to facilitate sharing content and data between communities and applications. In this way, content that

2240-539: The Google Guava library, the parts that are considered unstable, and that might change soon, are marked with the Java annotation @Beta . A public API can sometimes declare parts of itself as deprecated or rescinded. This usually means that part of the API should be considered a candidate for being removed, or modified in a backward incompatible way. Therefore, these changes allow developers to transition away from parts of

2304-682: The Java language in particular. In the 1990s, with the spread of the internet , standards like CORBA , COM , and DCOM competed to become the most common way to expose API services. Roy Fielding 's dissertation Architectural Styles and the Design of Network-based Software Architectures at UC Irvine in 2000 outlined Representational state transfer (REST) and described the idea of a "network-based Application Programming Interface" that Fielding contrasted with traditional "library-based" APIs. XML and JSON web APIs saw widespread commercial adoption beginning in 2000 and continuing as of 2021. The web API

2368-501: The Java remote method invocation API uses the Java Remote Method Protocol to allow invocation of functions that operate remotely, but appear local to the developer. Therefore, remote APIs are useful in maintaining the object abstraction in object-oriented programming ; a method call , executed locally on a proxy object, invokes the corresponding method on the remote object, using the remoting protocol, and acquires

2432-535: The Linux Standard Base provides an ABI. Remote APIs allow developers to manipulate remote resources through protocols , specific standards for communication that allow different technologies to work together, regardless of language or platform. For example, the Java Database Connectivity API allows developers to query many different types of databases with the same set of functions, while

2496-660: The healthcare industry , the Office of the National Coordinator for Health Information Technology (ONC) streamlined commonly used templates to create the Consolidated-CDA (C-CDA). The CDA standard doesn't specify how the documents should be transported. CDA documents can be transported using HL7 version 2 messages, HL7 version 3 messages, IHE protocols such as XDS , as well as by other mechanisms including: DICOM , MIME attachments to email , http or ftp . The standard

2560-417: The 1940s, though the term did not emerge until the 1960s and 70s. An API opens a software system to interactions from the outside. It allows two software systems to communicate across a boundary — an interface — using mutually agreed-upon signals. In other words, an API connects software entities together. Unlike a user interface , an API is typically not visible to users. It is an "under the hood" portion of

2624-525: The 2020 Eli Hurvitz Conference on Economy and Society, run by the Israel Democracy Institute it was estimated that the cost of implementing central FHIR modules of in the Israeli healthcare system is estimated at about 400 million NIS over 5 years. In 2023, the Israeli government began a legislative process to promote the sharing of information between organizations in the Israeli health ecosystem for

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2688-456: The API that will be removed or not supported in the future. Client code may contain innovative or opportunistic usages that were not intended by the API designers. In other words, for a library with a significant user base, when an element becomes part of the public API, it may be used in diverse ways. On February 19, 2020, Akamai published their annual “State of the Internet” report, showcasing

2752-435: The API. The term API initially described an interface only for end-user-facing programs, known as application programs . This origin is still reflected in the name "application programming interface." Today, the term is broader, including also utility software and even hardware interfaces . The idea of the API is much older than the term itself. British computer scientists Maurice Wilkes and David Wheeler worked on

2816-605: The HIPAA privacy rule (HHS–OCR–0945–AA00) with an expanded right of access for personal health apps and disclosures between providers for care coordination. Unlike the CMS and ONC final rules, the OCR HIPAA privacy proposed rule is not specific to FHIR; however, OCR's emphasize on standards-based APIs clearly benefits FHIR adoption. In 2020, Brazil 's Ministry of Health , by the IT Department of

2880-508: The National Coordinator for Health IT (ONC) Cures Act Final rule (HHS-ONC-0955-AA01) work in concert to drive FHIR adoption within their respective regulatory authorities. Further, other agencies are using existing rule-making authority, not derived from the Cures Act, to harmonize the regulatory landscape and ease FHIR adoption. For example, the U.S. Department of Health and Human Services (HHS) Office of Civil Rights (OCR) has proposed to update

2944-496: The POSIX APIs. Microsoft has shown a strong commitment to a backward-compatible API, particularly within its Windows API (Win32) library, so older applications may run on newer versions of Windows using an executable-specific setting called "Compatibility Mode". An API differs from an application binary interface (ABI) in that an API is source code based while an ABI is binary based. For instance, POSIX provides APIs while

3008-650: The SUS, started one of the world's largest platforms for national health interoperability, called the National Health Data Network, which uses HL7 FHIR r4 as a standard in all its information exchanges. In 2020, Israel 's Ministry of Health began working towards the goal of promoting accessibility of information to patients and caregivers through the adoption of the FHIR standard in health organizations in Israel. Its first act

3072-401: The application programming interface separately from other interfaces, such as the query interface. Database professionals in the 1970s observed these different interfaces could be combined; a sufficiently rich application interface could support the other interfaces as well. This observation led to APIs that supported all types of programming, not just application programming. By 1990, the API

3136-502: The benefit of the patient, with an emphasis on patient empowerment and reduced information blocking. The proposed legislation also refers to the need to standardize the data by adopting the FHIR standard and utilizing standard terminologies, such as SNOMED-CT , both in source systems and in the data exchange process. The sharing of information will be with the patient's consent, and this consent will be given according to data buckets. Application programming interface In contrast to

3200-485: The best possible care. The standard describes data formats and elements (known as "resources") and an application programming interface (API) for exchanging electronic health records (EHR). The standard was created by the Health Level Seven International (HL7) health-care standards organization. FHIR builds on previous data format standards from HL7, like HL7 version 2.x and HL7 version 3.x. But it

3264-513: The current practice of exchanging complex Clinical Document Architecture (CDA) documents, and instead exchange sets of simpler, more modular and interoperable FHIR JSON objects. The initial goal was to specify two FHIR profiles that are relevant to the Meaningful Use requirements, along with an implementation guide for using OAuth 2.0 for authentication. A collaboration agreement with Healthcare Services Platform Consortium (now called Logica)

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3328-420: The form of different libraries that share the same programming interface. The separation of the API from its implementation can allow programs written in one language to use a library written in another. For example, because Scala and Java compile to compatible bytecode , Scala developers can take advantage of any Java API. API use can vary depending on the type of programming language involved. An API for

3392-476: The growing trend of cybercriminals targeting public API platforms at financial services worldwide. From December 2017 through November 2019, Akamai witnessed 85.42 billion credential violation attacks. About 20%, or 16.55 billion, were against hostnames defined as API endpoints. Of these, 473.5 million have targeted financial services sector organizations. API documentation describes what services an API offers and how to use those services, aiming to cover everything

3456-490: The implementation details of the modules so that users of modules need not understand the complexities inside the modules. Thus, the design of an API attempts to provide only the tools a user would expect. The design of programming interfaces represents an important part of software architecture , the organization of a complex piece of software. APIs are one of the more common ways technology companies integrate. Those that provide and use APIs are considered as being members of

3520-452: The internal details later change. An API may be custom-built for a particular pair of systems, or it may be a shared standard allowing interoperability among many systems. The term API is often used to refer to web APIs , which allow communication between computers that are joined by the internet . There are also APIs for programming languages , software libraries , computer operating systems , and computer hardware . APIs originated in

3584-595: The programmer from dealing with idiosyncrasies of the graphics display device, and to provide hardware independence if the computer or the display were replaced. The term was introduced to the field of databases by C. J. Date in a 1974 paper called The Relational and Network Approaches: Comparison of the Application Programming Interface . An API became a part of the ANSI/SPARC framework for database management systems . This framework treated

3648-442: The result to be used locally as a return value. A modification of the proxy object will also result in a corresponding modification of the remote object. Web APIs are the defined interfaces through which interactions happen between an enterprise and applications that use its assets, which also is a Service Level Agreement (SLA) to specify the functional provider and expose the service path or URL for its API users. An API approach

3712-448: The similar OpenJDK project. Judge William Alsup ruled in the Oracle v. Google case that APIs cannot be copyrighted in the U.S. and that a victory for Oracle would have widely expanded copyright protection to a "functional set of symbols" and allowed the copyrighting of simple software commands: To accept Oracle's claim would be to allow anyone to copyright one version of code to carry out

3776-432: The syntax and supplies a framework for specifying the full semantics of a clinical document, defined by six characteristics: CDA can hold any kind of clinical information that would be included in a patient's medical record ; examples include: An XML element in a CDA supports unstructured text, as well as links to composite documents encoded in pdf , docx , or rtf , as well as image formats like jpg and png . It

3840-587: The use of FHIR by a variety of CMS-regulated payers, including Medicare Advantage organizations, state Medicaid programs, and qualified health plans in the Federally Facilitated Marketplace by 2021. Specifically, the rule requires FHIR APIs for Patient Access, Provider Directory and Payer-to-Payer exchange. Proposed rules from CMS, such as the patient burden and prior authorization proposed rule (CMS-9123-P), further specify FHIR adoption for payer-to-payer exchange. The CMS rules and Office of

3904-446: Was announced in 2017. Experiences with developing medical applications using FHIR to link to existing electronic health record systems clarified some of the benefits and challenges of the approach, and with getting clinicians to use them. In 2020, the U.S. Centers for Medicare & Medicaid Services (CMS) issued their Interoperability and Patient Access final rule, (CMS-9115-F), based on the 21st Century Cures Act . The rule requires

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3968-455: Was defined simply as "a set of services available to a programmer for performing certain tasks" by technologist Carl Malamud . The idea of the API was expanded again with the dawn of remote procedure calls and web APIs . As computer networks became common in the 1970s and 80s, programmers wanted to call libraries located not only on their local computers, but on computers located elsewhere. These remote procedure calls were well supported by

4032-714: Was developed using the HL7 Development Framework (HDF) and it is based on the HL7 Reference Information Model (RIM) and the HL7 Version 3 Data Types. The CDA specifies that the content of the document consists of a mandatory textual part (which ensures human interpretation of the document contents) and optional structured parts (for software processing). The structured part relies on coding systems (such as from SNOMED and LOINC ) to represent concepts. In 2012, in response to conflicting CDAs in use by

4096-575: Was to create the IL-CORE work team in order to adapt the necessary components for localization and regulation in the health system in Israel. The ministry, in cooperation with the Nonprofit Organization 8400, created the FHIR IL community, whose purpose is to encourage the adoption of the standard in the Israeli healthcare system while cooperating with healthcare organizations and the industry. As part of

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