FHIR in Focus: Enabling Biomedical Data Harmonization for Intelligent Healthcare Systems

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Fast Healthcare Interoperability Resources (FHIR), developed by Health Level Seven International (HL7), is a key framework addressing long-standing issues of interoperability barriers and data inconsistencies in healthcare data exchange. This review argues that FHIR provides a flexible foundation for integrating Electronic Health Records (EHRs), analytics platforms, and decision support tools amid global digital transformation. Its growth has been accelerated by policy mandates such as the 21st Century Cures Act, alongside the availability of APIs, SDKs, and web standards. It has been adopted or piloted in national health systems across the United States, United Kingdom, Canada, and Australia, and incorporated into WHO data initiatives. The review comprehensively maps FHIR applications across clinical, research, and public health domains, identifying both adoption barriers and enablers. Furthermore, it provides insights into integration with generative AI and large language models for predictive modeling, automated documentation, and decision support, offering guidance on future innovations like blockchain-enabled infrastructure and cloud-native scalability. However, challenges remain, including uneven implementation, workforce training gaps, scalability limitations, and unresolved concerns regarding privacy, security, and regulatory compliance. This paper offers actionable insights for providers, researchers, policymakers, and developers to advance global health interoperability.