
FHIR® and SMART on FHIR® Products
Data Quality in FHIR: Lessons from the Field
A presentation from HL7’s FHIR DevDays
Carol Graham, Clinical Architecture Product Manager, describes how implementers can close the gap between real-world use and the happy path use cases envisioned in interoperability standards, while complying with value set best practices, including HL7’s normative Value Set Definition standard. She addresses the importance of standardization and normalization on data quality within the FHIR resources.

Symedical® on FHIR™
Symedical® on FHIR™ is Clinical Architecture’s implementation of the HL7 FHIR Terminology Service specification. It provides a FHIR-based set of services customers may use to gain access to Clinical Architecture’s terminology and ontology assets. Customers may also use these services to provide access to their own content from within their own instance of Symedical, if desired. The functionality provides for code (term) lookups, validations, mappings to other code systems or value sets, determining hierarchical relationships between codes, and retrieving sets of codes and their descriptors. The FHIR Terminology service is based on commonly understood web standards: REST, XML, JSON, and HTTP.
FHIR Compatibility: R4, STU3 (R3), DSTU2
Pivot – Interoperability and data quality simplified
Pivot is an interoperability and data quality solution that combines format conversion, terminology normalization, de-duplication, and data validation into a single platform. Pivot takes in patient data in many formats (FHIR, CDA/C-CDA, HL7, and others), normalizes the data to the required code systems and value sets, validates the data, optionally performs de-duplication and other enhancements, and produces a standard, predictable patient message either in FHIR or any of the other available formats. It combines many of Symedical’s most powerful capabilities into a turnkey service, dramatically reducing the barriers and effort necessary to make high-quality patient information exchange a reality.
Unlike most interoperability platforms, which require custom interfaces for every message feed, Pivot is architected to isolate format transformations from normalization, validation, and other features, making it exceptionally easy to configure and integrate. It is stateless, reducing the cost and risk associated with duplicating patient data repositories, and it provides unparalleled flexibility and ease of implementation.
Pivot is suitable for use in a variety of settings and use cases, including IDNs/health systems, health information exchanges, analytics platforms, enterprise clinical data repositories, research settings, and more.
FHIR Compatibility: R4, STU3 (R3)

Inquire on FHIR™ – Your solution for healthcare questionnaires
Inquire on FHIR™ is a one-stop solution for electronic healthcare questionnaires. It provides a comprehensive, ready-to-use library of over 300 questionnaires covering Meaningful Use (MIPS/MACRA/CPC+), Social Determinants of Health, and a wealth of other functional, cognitive, and health assessments.
Providing clinically accepted, digitized questionnaires, Inquire on FHIR enables the clinician to quickly and easily complete a questionnaire, review the scoring and interpretation, and capture the details as part of the patient’s health record. It intelligently leads the clinician through the process of completing the questionnaire, only displaying questions that are relevant based on the combination of previously answered questions and clinical context such as patient gender, age, and provider specialty. Moreover, Inquire on FHIR can identify and recommend additional questionnaires that may be relevant based on the results of the completed questionnaire. Inquire on FHIR supports score calculations ranging from basic to very complex, providing scoring and interpretation precisely as intended by the publisher of the questionnaire.
Enabled via SMART on FHIR®, Inquire is easy to implement. A clinical system that supports SMART on FHIR can utilize the questionnaires and store the results either as a digital document or as FHIR-based structured information.
FHIR Compatibility: R4, STU3 (R3), DSTU2

Awareness on FHIR™
Awareness on FHIR™ is Clinical Architecture’s clinical decision support solution enabled via SMART on FHIR®. Using a sophisticated rules engine and leveraging rich ontologies from Symedical®, the industry-leading terminology management, semantic interoperability, and data quality platform, Awareness on FHIR uses structured clinical data to draw assertions and provide feedback to the clinician in the form of recommendations, relevant patient instance evidence, and supporting references. It evaluates patient records ingested into the engine through FHIR1 to deliver advanced clinical decision support either at the point of care or for a population.
Common use cases supported by Advanced Clinical Awareness include the following:
- Detect undiagnosed/undocumented patient conditions
- Identify risk across individuals and populations
- Maximize appropriateness of care
- Proactively optimize process- and outcome-oriented quality measures
- Succeed with risk-based contracts
FHIR Compatibility: R4, STU3 (R3)
1 Other data formats such as CCD/C-CDA, HL7 v2.x, and HealthShare SDA are available via Clinical Architecture’s Advanced Clinical Awareness solution.
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