Assessing the use of HL7 FHIR for implementing the FAIR guiding principles: A case study of the MIMIC-IV emergency department module

<p><strong>Objective</strong> <br>To assess the use of Health Level Seven Fast Healthcare Interoperability Resources (FHIR^®) for implementing the Findable, Accessible, Interoperable, and Reusable guiding principles for scientific data (FAIR). Additionally, present a list of FAIR implementation choices for supporting future FAIR implementations that use FHIR. <br><br><strong>Material and Methods</strong> <br>A case study was conducted on the Medical Information Mart for Intensive Care-IV Emergency Department dataset (MIMIC-ED), a deidentified clinical dataset converted into FHIR. The FAIRness of this dataset was assessed using a set of common FAIR assessment indicators. <br><br><strong>Results</strong> <br>The FHIR distribution of MIMIC-ED, comprising an implementation guide and demo data, was more FAIR compared to the non-FHIR distribution. The FAIRness score increased from 60 to 82 out of 95 points, a relative improvement of 37%. The most notable improvements were observed in interoperability, with a score increase from 5 to 19 out of 19 points, and reusability, with a score increase from 8 to 14 out of 24 points. A total of 14 FAIR implementation choices were identified. <br><br><strong>Discussion</strong> <br>Our work examined how and to what extent the FHIR standard contributes to FAIR data. Challenges arose from interpreting the FAIR assessment indicators. This study stands out for providing a real-world example of a dataset that was made more FAIR using FHIR. <br><br><strong>Conclusion</strong> <br>To the best of our knowledge, this is the first study that formally assessed the conformance of a FHIR dataset to the FAIR principles. FHIR improved the accessibility, interoperability, and reusability of MIMIC-ED. Future research should focus on implementing FHIR in research data infrastructures. Keywords: FAIR Guiding Principles, HL7 FHIR, Reusable Data, MIMIC-IV</p>