NLM taps EHRs, FHIR to improve sharing of medical research data

The National Library of Medicine is developing analysis tools to mine electronic health records to help discover adverse drug reactions, identify promising drug targets and detect transplant rejection earlier.

Director Patricia Flatley Brennan told a House appropriations subcommittee late last month that NLM is working on tools to facilitate research use of HL7’s Fast Healthcare Interoperability Resources (FHIR) standard, which is being widely adopted for use in EHR systems.

“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,” said Brennan in her testimony. “NLM produces a range of tools to help EHR developers and users implement these standards and makes them available in multiple formats including via application programming interfaces, or APIs.”

FHIR is a standardized method of transmitting health data from one EHR system to another through an API, a specified set of protocols and standards that establish the ground rules by which one system directly communicates with another.

NLM’s efforts are in accordance with a National Institutes of Health notice issued in July encouraging NIH-funded researchers to explore the use of the FHIR standard to capture, integrate and exchange clinical data for research purposes and to enhance capabilities to share research data.


“NIH plans to issue a Request for Information to solicit input from the scientific community and other stakeholders about the types of tools that might be needed to support use of FHIR in biomedical research, as well as implementation challenges and opportunities they foresee in using FHIR, including privacy, security and protection of patient data,” states the July notice.

NLM, part of NIH, is the world’s largest biomedical library and has long been a repository of journal articles and databases to support scientific breakthroughs. However, its digital information services have been broadened to leverage EHRs.

Case in point is NLM’s MedlinePlus Connect, a free service that enables healthcare organizations and health IT vendors to link patient portals and EHR systems to MedlinePlus—a medical information resource for patients, families and providers.

Available as a web app or service, MedlinePlus Connect accepts and responds to requests for information based on diagnosis, medication and laboratory codes. When an EHR, patient portal or other system submits a code-based request, MedlinePlus Connect returns a response that includes links to health information relevant to the specific code.

“As a major force in health data standards for more than 30 years, NLM’s investments have led to major advances in the ways high volume research and clinical data are collected, structured, standardized, mined and delivered,” according to Brennan. “In close collaboration with other HHS agencies, NLM develops, funds and disseminates clinical terminologies designated as essential for demonstrating meaningful use of EHRs and health information exchange."