On the Trustworthiness of FHIR-Based Internet-of-Things Digital Health Systems

Modernization in healthcare has led to new trends, such as using the Internet of Medical Things (IoMT) to collect millions of health-related data points within digital health systems daily. Fast Healthcare Interoperability Resources (FHIR) has been proposed and widely adopted as an efficient method for exchanging healthcare information in digital health environments. As the emergence of FHIR-based health systems continues to grow, assessing the reliability of such FHIR systems is essential. To the best of our knowledge, no literary work addresses this gap. In this study, for the first time, we explore the trustworthiness of FHIR-based healthcare systems by identifying several relevant fault models and introducing two metrics that can help measure the reliability of FHIR-based systems. Our proposed metrics give a rough estimation of the interoperability and trust of a given FHIR-based health system. Using our proposed metrics, we evaluated a unique instance of the publicly available HAPI FHIR Test system.