Fast Healthcare Interoperability Resources (FHIR) Tip Sheet

by Alexandra (Ford) Hubach RHIA, MSHI, CRCR & Frantia Dozier, RHIA

FHIR for the HIM Professional
Key Considerations for FHIR Related Discussions

Executive Position Statement

Fast Healthcare Interoperability Resources (FHIR) is a federally mandated interoperability standard that directly impacts patient access, data governance, coding integrity, compliance, and audit accountability. While frequently implemented by technical teams, FHIR operationalizes structured clinical data, an established domain of the Health Information Management (HIM) profession. As interoperability requirements expand, FHIR competency is becoming essential to HIM leadership in data stewardship and regulatory compliance roles.

What is FHIR

FHIR stands for Fast Healthcare Interoperability Resources. It is a next level interoperability standard created by HL7.

FHIR, developed by Health Level Seven International (HL7), is a standard for health information exchange using RESTful APIs and structured data 'Resources' (e.g., Patient, Observation, Condition, Encounter, Medication Request). Certified health IT systems are required to support FHIR-based APIs to enable standardized access to United States Core Data for Interoperability (USCDI) elements under the 21st Century Cures Act Final Rule.

Why is This Important?

In the CMS Interoperability and Patient Access final rule, CMS required certain payers to implement an HL7 FHIR Patient Access API. CMS is requiring some payers to add information about prior authorizations (excluding those for drugs) to the data available via that Patient Access API. This will empower patients to access to more of their data and help them understand the prior authorization process. This requirement must be implemented by January 1, 2027. FHIR is also enforced in the ONC 21st Century Cures Act Final Rule*, which requires standardized API access to defined United States Core Data for Interoperability (USCDI) data elements and prohibits information blocking practices. FHIR standardizes transport, but does not ensure data quality. Data governance remains HIM responsibility. FHIR increases accountability for terminology mapping, provenance tracking, and audit controls. HIM professionals should manage these mapping, tracking and audit processes to ensure patient privacy and regulation compliance.

Key Considerations for the HIM Professional

HIM professionals should always have a seat at the table for discussions regarding the exchange of healthcare related data.

Key Questions to ask yourself and stakeholders in your organization include: 

• Do you understand the encryption and data security mechanisms?
• What is the data security and audit policy for the exchange?
• What is the turn around on security risks?
• What are your responsibilities, under the standards in the AHIMA data governance practice brief, to ensure data quality, data governance, and best practices?
• FHIR transmits data exactly as documented; free text documentation limits interoperability and downstream usability; how can your organization be a good steward of your data and maximize data assets?
• What are all the interfaces sending PHI using FHIR? Are they cataloged and routinely validated?
  

*The ONC 21st Century Cures Act Final Rule requires health IT systems to support secure, seamless access and exchange of electronic health information, giving patients more direct control over their data. It also prohibits information blocking and promotes interoperability by pushing developers and providers to adopt standardized APIs and share data more freely.

 

Works Cited

AHIMA. “Healthcare Data Governance.” AHIMA Body of Knowledge, https://bok.ahima.org/topics/healthcare-data-lifecycle/healthcare-data-governance/..

Centers for Medicare & Medicaid Services. Interoperability and Patient Access Final Rule (CMS‑9115‑F). 2020.

Centers for Medicare & Medicaid Services. “CMS Interoperability and Prior Authorization Final Rule (CMS‑0057‑F).” CMS.gov, https://www.cms.gov/newsroom/fact-sheets/cms-interoperability-and-prior-authorization-final-rule-cms-0057-f.

HealthIT.gov. . What Is FHIR? Fact Sheet. Office of the National Coordinator for Health Information Technology, Apr. 2021, https://www.healthit.gov/sites/default/files/page/2021-04/What%20Is%20FHIR%20Fact%20Sheet.pdf.

Healthcare Financial Management Association. ONC 21st Century Cures Act Final Rule Summary. HFMA, Oct. 2022, www.hfma.org/wp-content/uploads/2022/10/onc-cures-act-final-rule-summary.pdf.HL7 International. “FHIR Overview.” HL7.org, https://www.hl7.org/fhir/overview.html.

Office of the National Coordinator for Health Information Technology. 21st Century Cures Act Final Rule (45 CFR Part 170). 2020.

Office of the National Coordinator for Health Information Technology. United States Core Data for Interoperability (USCDI).

Click here to download a PDF copy of this resource.

About the Authors

 

Alexandra (Ford) Hubach, RHIA, MSHI, CRCR, is a Project Leader on the Advocacy Pillar of the OHIMA FY 2025-26 Board of Directors. Alex is employed by Guidehouse as a Senior Consultant.

  

 

 

 

 

 

 

 

 

Frantia Dozier, RHIA, is a Project Leader on the Advocacy Pillar of the OHIMA FY 2025-26 Board of Directors. Tia is employed by BeechAcres Parenting Center supporting Information Technology and Data.

Cultivating Growth in Your HI Career

by Dianna Foley, RHIA, CCS, CDIP, CHPS

As we move beyond the success of OHIMA26—where the theme “From Buds to Blooms: Building HI Together” truly flourished—we now find ourselves in the midst of Health Information Professionals Week. This season offers a meaningful opportunity to celebrate both our collective achievements and our individual growth within the field of health information management. It is also an ideal time to pause, reflect, and assess where new opportunities may be ready to take root in your career.

Like any thriving garden, a successful HI career requires ongoing care and cultivation. For coding professionals, this may mean extending new branches into auditing as the landscape evolves alongside AI-assisted coding. Others may choose to dig deeper into the intricacies of release of information (ROI), nurturing their expertise and obtaining the specialized ROI micro-credential. Continuing education—whether through articles, blogs, or professional development—serves as the fertilizer that enriches knowledge and supports sustained growth. Exploring areas such as compliance can also allow your career to branch out in new and rewarding directions.

Volunteering within the HI community is another powerful way to enrich your professional soil. Contributing your time and expertise—whether through state associations, national organizations, or local initiatives—helps cultivate leadership skills, expand professional networks, and strengthen the roots of the profession as a whole. Volunteering provides opportunities to cross-pollinate ideas, gain new perspectives, and develop competencies that may not be fully realized in day-to-day roles. These experiences often lead to unexpected growth, opening doors to new roles, responsibilities, and connections.

The HIM profession offers fertile ground for growth—not only for yourself but for those around you. Supporting colleagues, sharing knowledge, and mentoring emerging professionals helps cultivate a strong and resilient workforce. While planting the seeds of success takes time and dedication, guiding new professionals as they take root and grow into confident contributors is both impactful and rewarding. Volunteering can further enhance this process, allowing you to serve as both a mentor and a steward of the profession’s future.

As you continue tending your professional garden, consider where you can invest your time and energy to yield the greatest growth. Whether you are planting new seeds through education, pruning and refining existing skills, or volunteering to help others flourish, each effort contributes to a vibrant and sustainable HIM community.

With intentional care, continuous learning, and a willingness to give back, your HIM career can continue to grow, thrive, and bloom in meaningful and fulfilling ways.

 

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.

April Showers Mishaps

by Dianna Foley, RHIA, CHPS, CCS, CDIP

Test your ICD-10-CM injury and external cause knowledge by coding the scenarios below.

Spring has arrived and with it comes the familiar saying, “April showers bring May flowers.” For the Klutz family, however, April showers often bring something else entirely—minor injuries and a chance for you to test your coding knowledge once again.

One afternoon, the Klutz children were playing outside after a soaking spring shower. Raymond decided it would be fun to jump across the puddles along the sidewalk. Unfortunately, one of the puddles was wider than expected. His foot slipped on the wet pavement and he fell, striking his right elbow on the sidewalk. While it hurt and quickly bruised, nothing appeared to be broken.

Little Dana was busy wearing her bright yellow rain boots and splashing happily in the puddles in the front yard. During one enthusiastic jump, she slipped in the mud and landed on her bottom. The result was a bruised tailbone and a few muddy tears before her mother helped her back inside.

Meanwhile, Peter was riding his bicycle down the wet driveway, ignoring his mother’s warning about slippery pavement. As he turned toward the street, the bicycle tires slid on the wet surface and he fell off, scraping his left knee.

Janine decided to help bring the family’s recycling bin back up the driveway after the rain stopped. While pushing the heavy bin across the slick concrete, it tipped backward and fell onto her right foot. The foot quickly became swollen and painful, but fortunately the doctor later confirmed it was only bruised.

Egon, determined to prove he could run faster than the rain, dashed across the backyard to grab a soccer ball he had left outside. The grass was still soaked, and he slipped, twisting his left ankle in the process. A quick trip to urgent care confirmed a sprained ankle.

Fortunately for the Klutz family, these April showers only resulted in minor mishaps. Mr. and Mrs. Klutz were content that the puddle-jumping and rainy-day activities didn’t result in much more serious mishaps-at least for now!

Click HERE for the answers.

 

Cerebral Embolic Protection

This month, “In the kNOW” covers the ICD-10-PCS codes that are to be used for cerebral embolic protection.

With the October 1^st 2025 ICD-10-PCS code updates, coding professionals gained a way to capture the use of cerebral embolic protection used in conjunction with procedures such as TAVRs (transcatheter aortic valve replacements). These devices are deployed as guardians of the brain. They trap any debris that becomes dislodged during a procedure, thereby preventing a stroke. 

These devices are routinely used during those types of surgical procedures, but because they were removed once the procedure was completed, they were not coded as devices. You’ll recall that in ICD-10-PCS, the definition of devices is that they remain after the procedure is complete. Previously, in order to capture these devices, a New Technology code was assigned. Now, these codes have been moved into the Medical/Surgical section of ICD-10-PCS by adding a new row to the 5A0 table (Extracorporeal or Systemic Assistance and Performance, Physiological Systems, Assistance) with the Duration character (character 5) providing the option Intraoperative. The Qualifier character (character 7) denotes the specific type of filter used. The options for the filter types are:

• M   Single-capture filter
• N    Dual-capture filter
• P     Single deflection filter
• Q    Extracorporeal Flow Reversal Circuit

The revised ICD-10-PCS table is shown below.

Here are examples of each type of filter:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Flow reversal, seen above, temporarily redirects blood flow away from the brain, sending the blood through a filter, and then back into the body through a lower extremity vein. 

Now you are In the kNOW!!

 

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.