JMIR Publications

ABSTRACT

Background:

Referral linkages are crucial for the efficient functioning of Primary Health Care (PHC) systems. Fast Healthcare Interoperability Resource (FHIR) is an open global standard that facilitates structuring health information for coordinated exchange amongst stakeholders.

Objective:

The objective of this study is to profile, present methodology and the profiled FHIR resource for Maternal and Child Health (MNCH) referral use case in Ebonyi state, Nigeria, a typical Low-and-Middle-Income-Country (LMIC) setting.

Methods:

Practicing doctors, midwives, and nurses were purposefully sampled and surveyed. Different referral forms were reviewed. The union of datasets from surveys and forms was aggregated and mapped to base patient FHIR resource elements, and extensions were created for datasets not in the core FHIR specification. This study also introduced FHIR and its relation to the WHO International Classification for Disease (ICD).

Results:

We found that there were many different data elements from the referral forms and survey responses even in urban settings. The resulting FHIR standard profile is published on GitHub for adaptation or adoption as necessary. Understanding datasets used in healthcare and clinical practice for information sharing is crucial in properly standardizing information sharing, particularly as the world manages COVID-19 and other infectious diseases. Development organizations and governments can use this methodology and profile to fast-track FHIR standards adoption for paper and electronic information sharing at PHCs in LMICs.

Conclusions:

We presented our methodology for profiling the referral resource crucial for the standardized exchange of new and expectant moms’ information. Using data from frontline providers and mapped to the FHIR profile helped contextualize the standardized profile.