Health-Tech
Why FHIR Matters to the Future of Healthcare
By Miracle Olajuyigbe 5 min read
Think about what your bank can do.
You can open an app and see accounts held at three different institutions. You can send money to a stranger’s account at a different bank, in a different country, and it lands in seconds. None of those banks are friends. None of them built their systems together. They simply agreed, decades ago, on a shared way of describing what a payment is.
Now think about what happens when you change hospitals.
You carry a brown envelope. Somebody photocopies things. You recite your medications from memory and get one of them slightly wrong. A scan you had six weeks ago cannot be found, so you have another one. Two large organisations, both fully computerised, both holding detailed records about you, and the mechanism for moving information between them turns out to be a tired person in a waiting room trying to remember the name of a tablet.
The gap between those two experiences is not about technology being harder in medicine. It is about healthcare never having agreed on a shared way of describing things. FHIR is the most serious attempt anyone has made at that agreement, and it is worth understanding even if you never touch a line of code.
What the word means
FHIR stands for Fast Healthcare Interoperability Resources. It is pronounced “fire,” and the acronym is doing a lot of work, so let me unpack the part that matters.
The important word is resources.
Older approaches to sharing medical records moved documents around. A whole discharge summary, a whole referral letter, sent from one system to another as a single lump. Useful, but clumsy. If all you wanted was the patient’s latest kidney function result, you received a fourteen-page document and went looking for it.
FHIR breaks medical information into small standard pieces instead. There is a standard shape for a patient. A standard shape for a single lab result. One for a prescription, one for an allergy, one for a diagnosis, one for an appointment.
Think of them as Lego bricks. Every system that speaks FHIR builds from the same set of bricks, in the same shapes, with the same studs in the same places. Which means a piece built by one hospital’s system clicks into an application written by somebody who has never met them.
And because the pieces are small and individually addressable, software can ask precise questions. Not “send me everything about this patient” but “send me this person’s blood pressure readings from the last year.” That sounds like a small change. It is the whole thing.
Why it caught on when earlier attempts did not
People have been trying to solve this since the 1980s, and previous standards did work, in a fashion. They were also difficult, expensive, and required specialists who spent careers learning their quirks. Connecting two hospitals was a project with a budget and a timeline.
FHIR made two decisions that changed the economics.
The first is that it works like the rest of the internet. Requesting a patient’s records over FHIR looks much like any other web request, and the data comes back in the same everyday format that powers most modern apps. That means an ordinary software developer can build something useful for healthcare without first spending two years learning healthcare’s private dialect. The pool of people who can build in this space got very much larger, very quickly.
The second is timing. Regulators, particularly in the United States, stopped treating data sharing as a nice-to-have. Rules now require certified health record systems to offer standardised access, and deliberately obstructing the flow of patient information carries penalties. That converted FHIR support from something a vendor might advertise into something they have to provide, which is a far more reliable way to get an industry to move.
What it makes possible
Applications that work everywhere. Before, a clinical app had to be rebuilt for each hospital system it was sold into. Now one application can plug into many, which means good tools reach more places and small teams can build things without an enterprise sales budget first.
Records that follow the patient. This is the version most people care about. Your history, your medications, your results, available to whoever is treating you, without you having to remember or carry anything.
Better use of the data we already collect. Research, quality improvement, and yes, the AI everyone is excited about, all depend on being able to assemble information across systems, which is why so many promising projects stall not on the clever part but on the unglamorous business of getting the records into one place. A model is only as good as the data it can reach. Most healthcare data currently cannot be reached.
Fewer repeated tests. Every duplicated scan is a cost, a delay, and sometimes a dose of radiation somebody did not need.
What it does not fix
I would rather be honest about the limits than sell you the clean version.
Agreeing on the container is not agreeing on the contents. Two hospitals can both use FHIR perfectly and still disagree about what counts as an active problem, or use different internal codes for the same lab test. The envelope is standardised. What people write inside it is a local habit, and local habits vary enormously.
Technology does not change incentives. If a health system quietly benefits from patients finding it difficult to leave, a standard will not persuade them otherwise. Regulation has pushed hard against this and moved things measurably. It has not made the underlying tension disappear.
Consent and access are still unsettled. Who is allowed to see what, for what purpose, and how you say no. FHIR gives you ways to record those decisions. Whether organisations agree on a shared policy and actually honour it is a legal and political question, and it is the one that most often stalls a technical connection that works perfectly.
And it assumes there is a digital record to begin with. In much of the world, including plenty of places I have worked, the record is on paper or in a system with no way to reach it from outside. The meaningful question there is not which version of a standard to adopt. It is whether the referral letter arrives at all.
Where this goes
The direction is fairly clear even if the timeline is not. Records that move with the patient rather than sitting with the institution. Health apps that plug into your actual medical history instead of asking you to type it in again. Clinicians who open a chart and see the whole picture rather than the slice their own organisation happens to hold, which is the thing that quietly causes more avoidable harm than most people outside medicine would guess.
FHIR is not the future of healthcare by itself. It is the plumbing that makes several possible futures buildable, and plumbing is unglamorous right up until you notice how much depends on it.
The brown envelope should not still be a thing. This is the most credible reason to think it eventually will not be.