National Library of Medicine Promoting EHRs & FHIR for Improving of Clinical Research

Oct 9, 2019 | FHIR, Medical Informatics, Research

The National Library of Medicine embraces Fast Healthcare Interoperability Resources (FHIR), a health data interoperability standard, so that medical researchers can mine electronic health records not only to help identify adverse drug events but also to identify promising drugs, detect transplants earlier, and possibly even identify patients for studies.

Greg Slabodkin with Health Data Management recently reported on this interesting initiative with significant potential for considerable research advancements. After all, most health systems and major providers now have invested in electronic health records (EHRs) driven by the Affordable Health Act (AHA) mandates of the Obama-era presidency. Meaningful use was next—where, among other things, providers and health systems would collaborate and coordinate care across systems, communities and even regions.

National Library of Medicine (NLM) Tool

Now the NLM is stepping up its game—with its leaders such as Director Patricia Flatley Brennan going in front of the House appropriations subcommittee to discuss the NLM’s work to support the leveraging of HL7 and FHIR for medical research reports Mr. Slabodkin.

As reported in her testimony as reported in Health Data Management, “The goal is to ensure that clinical data created in one system can be transmitted, interpreted and aggregated appropriately in other systems to support healthcare, public health and research.” She continued, “NLM produces a range of tools to help EHR developers and users implement these standards and make them available in multiple formats including via application programming interfaces, or APIs.”

National Institutes of Health (NIH) Notice to Use FHIR

The NIH issued a notice in July suggesting that NIH-funded researchers explore the use of the FHIR standard in their research endeavors involving the capture, integration and exchange of clinical trials data for research objectives.

Who is the NLM?

Part of the NIH, they are world’s largest biomedical library—a nexus of publications, databases and evidence of breakthroughs to support researchers. Based in Bethesda, MD, the NLM collects more than seven million books, journals, technical reports, manuscripts, microfilms, photographs and images on medicine and related sciences including some of the world’s oldest and rarest works.

The Blue Button Conference Notices

The NLM announced two notices back in the summer issued by the NIH regarding FHIR at the Blue Button Developer Conference held at the White House Eisenhower Executive Office Building in Washington DC. They included 1) The Guide Notice on FHIR which encourages NHI-funded investigators to explore the use of FHIR to capture, integrate, and exchange clinical data for research purposes and to enhance capabilities to share research data.  Importantly, the Guide seeks to make researchers aware of the of the emerging ability to extract data from EHRs using FHIR for example; and 2) NIH posted a Notice of Special Interest to inform the small business innovation research and small business technology transfer communities of NIH’s interest in supporting applications that use FHIR in the development of health information technology products and services.

FHIR, EHRs & Patient Recruitment: The University of Erlangen- Nurnberg Study

TrialSite News principals have had extensive experience in patient recruitment initiatives in past years not to mention portal development that includes interfacing an investigator portal with EHR data. Hence, this recent study out of Germany caught our interest. As the NLM has established some value-added use cases for FHIR and medical research one prominent area of interest for many sponsors includes the leveraging of FHIR and EHR data for better and faster site qualification and study start up.

The study’s authors noted that clinical trials represent the foundation of evidence-based medicine and that their digitization represents a fundamental theme in medical informatics. The representation of eligibility criteria in a machine-readable format for automation to rapidly identify participants for a study was the topic of the German study.

The research team, from the Medical Informatics department from University of Erlangen-Nurnberg  in Erlangen, Germany found that by leveraging HL7 FHIR  with a random subset of 303 eligibility criteria from, yielded a34% success rate in representing them using the FHIR search semantics. FHIR search semantics represent an important potential tool to support preliminary trial eligibility assessment.


The NLM is on to something positive with its guidance for researchers to consider embracing HL7/FHIR-based health records and interoperability. Researchers and medical informatics professionals should keep an eye on NLM’s initiatives.

Lead Research/Contact

Patricia Flatley Brennan, Director


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