HL7 FHIR proficiency certification preparation for clinicians (and non-clinicians)

[The original story was posted on LinkedIn 12th January 2021: https://www.linkedin.com/pulse/fhir-certification-preparation-clinicians-also-derek-buchanan/]

INTRODUCTION TO HL7 FHIR

HL7® Fast Healthcare Interoperability Resources (FHIR®) is one of the most anticipated interoperability standards in healthcare today. The standard is currently at release 4 (FHIR R4), with release 5 (FHIR R5) on the near horizon. Around the world, countries are looking at how to solve issues with interoperability, and in New Zealand (where I’m located), it has been included as part of the national interoperability roadmap.

With the rapid evolution in the healthcare IT domain, it may be timely for clinicians to consider whether a deeper knowledge of the specification could be of value. Certification is one way to demonstrate that a level of knowledge has been attained, and maybe a great segue to new opportunities.

In this blog, I will outline an approach to preparing for the FHIR certification exam, as well as other foundational knowledge that will assist in understanding core material. The recommendations, while not overly inclusive, may give vital guidance in your journey toward FHIR proficiency certification. This is a perspective piece and not representative of the views of HL7 or it’s affiliates.

PERSONAL BACKGROUND

To start with, a little information about myself… My journey with FHIR began in 2017, following attending the HL7 NZ mid-year conference. I work as a medical doctor and attended the session due to an interest in SNOMED-CT. Following the completion of the SNOMED-CT foundation course, my interest in FHIR grew. This led to enrolling in the HL7 Fundamentals course and HL7 FHIR Fundamentals course. This proved an excellent segue into understanding FHIR, but also its relation to V2.x, V3 RIM and CDA standards. Earlier health informatics study had exposed me to the concept of clinical coding, and FHIR helped foster my understanding of the concepts related to data exchange, messaging and documentation. I had benefited from covering some important foundational material as part of software engineering study, which included database concepts, XML and JSON (Javascript Object Notation) programming, and UML (Unified Modelling Language).

TO PASS THE EXAM (IMHO)

What you’ll need

• a structured approach
• an open mind to learning new (and at times difficult) things
• adequate preparation time and investment of resource

Prep: Suggested courses

- XML and JSON knowledge to assist foundational understanding — this will assist in understanding the why. I’d also suggest at least understanding UML. There are several free and paid courses for XML, JSON and UML While not critical for the FHIR exam, I believe that it assists foundational knowledge. [Links at bottom of page]

- HL7 FHIR Fundamentals course (4 weeks — self-directed learning with weekly activities)

- Also suggested would be the HL7 Fundamentals course (12 weeks — self-directed learning with weekly activities)

- HL7 now offers a new comprehensive FHIR preparation course and FHIR Intermediate courses

Prep: A bit about the HL7 courses

The HL7 Fundamentals and HL7 FHIR fundamentals course were excellent, offering course books and materials. The course was self-paced, although did have weekly assessments. For the HL7 fundamentals course, there were 3 -4 areas that need to be passed to complete the FULL course. If you were unable to pass some components, then only the completed components are listed on the course cert (CDA, v2.x, v3, FHIR).

The HL7 Fundamentals and FHIR fundamentals courses are run by veterans of the FHIR/HL7 world. Fernando Campos and Diego Kaminker have done a great job in setting up these courses, and the tutors for the assessments work with the standards and are certified across various HL7 standards. While practical labs are not part of the current FHIR assessment process, they offer a way to further understand the practical application ofthe standard. The various quiz questions (while not the same), give a chance to check knowledge.

The official course guides are helpful to strengthen understanding of FHIR and other HL7 standards. However, it is crucial to understand that the exam checks knowledge from the online published HL7 FHIR standard website. Therefore, while the course guides are excellent, they are not a substitute to further comprehensive learning from the website.

Prep: The official practice exam/test

There is an official practice test that can be accessed and purchased from the HL7 Website. Understanding the exam pattern can be achieved by doing these practice test questions. At the time that I sat (July 2019), there were no other practice sets available. This is quite different from well-known exams such as the Microsoft Azure, AWS, Google, Oracle exams — where there are many sites offering practice exam questions.

THE EXAM

What is the pass mark?

• This exam is no different than many other technical exams where a passing mark of >70% is required. While this might appear difficult at first, this is less than HL7 CDA exam pass mark of >90%.

What are the pass rates?

• Pass rates are not made readily available, but likely that with exams of this nature that there is a reasonable-to-high attrition rate.

What material is this based upon?

• The exam is based upon the official FHIR standard that is published online at https://www.hl7.org/fhir/
• Please keep in mind that the version may change soon, but for the moment is R4 (release 4).

EXAM DAY

Exam candidates are prohibited from discussing the contents of the exam. Therefore, a rudimentary and general approach will be described below.

1. Firstly, carefully review the provided exam information material. This will give an idea of the exam breakdown, and areas where to focus your study. This could assist the weighting of where to direct your attention, but a thorough knowledge of the standard will increase the probability of passing.
2. Secondly, timing is critical for the exam, and it is likely that for many question types, that careful consideration of each part is given. A combination of preparation, precision (and possibly luck) will likely yield a successful outcome. Having a clear mind on the exam day will ensure that you can comprehend the material in the best way. Due to the nature of questions, it will feel that the number of questions is more, and the amount of reading for many questions will test your ability to manage cognitive load.
3. Finally, there are options to sit the exam at home (via online proctoring) or to sit at a testing centre (subject to COVID-19 restrictions of course). I prefer to choose to sit at home due to the time spent travelling to testing centres.

OUTCOMES

Scenario 1: PASSED THE EXAM

• Congratulations! You’ve managed to clear the certification exam. I’d suggest you celebrate and share your achievements with your wider networks.

Scenario 2: FAILED THE EXAM

• With the benefit of hindsight, our pure IT brethren are more accustomed to sitting many of these types of exams. Exams of this nature are deliberately hard to ensure that the requisite level of knowledge is reached. The chance of failure may be off-putting to pursue this certification, as it may lie outside a clinicians immediate area of interest. I had to do this exam more than once and I can say that diligence and persistence can get you through. It takes heart to keep going until you succeed. One helpful description (that also nicely aligns with cognitive re-framing) is the acronym FAIL (First Attempt In Learning). As such, don’t be put off by your first-attempt-in- learning if this occurs, and don’t hesitate from engaging in further learning before trying again. I’m sure that you’ll get there.

Whatever the case, I wish you well in your FHIR journey. Best of luck!

HL7 Links:

• Official FHIR standard
• FHIR proficiency cert exam link — has other helpful links to intro/webinars
• FHIR fundamentals course
• **NEW** Comprehensive FHIR preparation course
• FHIR intermediate course
• HL7 fundamentals course
• Official HL7 website
• Official FHIR practice test

Additional links:

• UML general information site
• XML information — W3 Schools
• JSON introduction — W3 Schools

Information about few other standards (not exhaustive sorry)

• SNOMED-CT International
• — SNOMED-CT Foundation course — for those interested. Might be FREE if member country
• OpenEHR
• BPM+ Health — a maturing standard that I think is also worth knowing about

— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — DISCLAIMER: Please be aware that I have put together this personal perspective resource in the hope of enabling more people to complete the FHIR exam. These views are solely my perspective and do not represent the views of HL7 (or it’s affiliates). Any information herein is a personal opinion and to be used at your discretion.

I do not accept any personal liability for the suggestions that are published herein and suggest that you seek further/alternate opinion before deciding to proceed with courses or exams. I welcome any feedback/suggestions to the current version.