Embedding FHIR in Medical PDF: A Migration Path for Interoperable Documentation

Studies in health technology and informatics, vol. 331, pp. 186–194

Abstract

INTRODUCTION: Medical services routinely transmit patient data using PDF, even as FHIR emerges as the standard for structured healthcare interoperability. This mismatch reflects a broader fragmentation in digital documentation, where pragmatic workflows often outpace technical ideals. METHODS: We propose embedding FHIR bundles into PDF to enable structured data reuse without disrupting established processes. These hybrid documents can be processed via FHIR Binary endpoints, allowing downstream systems to extract, validate, and map the embedded data to interoperable resources. RESULTS: A proof-of-concept using German emergency medical services records demonstrates that vital parameters and timestamps can be transmitted as PDF while preserving machine-readable structure. CONCLUSION: This approach respects existing transport mechanisms and accommodates heterogeneous IT landscapes. By bridging legacy formats with modern standards, the method offers a scalable migration path toward interoperability-ready to deploy wherever PDF are already in use. Thus, our approach provides a migration pathway for integrating routine data into interoperable research infrastructures, enabling structured reuse without altering clinical workflows.

Authors 10

1. Jonas Bienzeisler Aachen Institute of Medical Informatics

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Institute of Medical Informatics, University Hospital RWTH Aachen, Germany

2. Alexander Kombeiz Aachen Institute of Medical Informatics

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Institute of Medical Informatics, University Hospital RWTH Aachen, Germany

3. Hauke Heidemeyer Aachen Institute of Medical Informatics

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Institute of Medical Informatics, University Hospital RWTH Aachen, Germany

4. Miriam Katharina Hertwig Aachen Emergency Department

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Emergency Department, University Hospital RWTH Aachen, Germany

5. Bernadett Erdmann
   Affiliation as printed

   Emergency Department, Klinikum Wolfsburg, Wolfsburg, Germany

6. Marco Pegoraro Aachen Chair of Process and Data Science

   RWTH Aachen University

   Affiliation as printed

   Chair of Process and Data Science, RWTH Aachen University, Aachen, Germany

7. Saskia Ehrentreich

   Otto-von-Guericke-Universität Magdeburg

   Affiliation as printed

   IPHAM, Otto von Guericke University, Magdeburg, Germany

8. Jasmin Mosebach
   Affiliation as printed

   ZTM Bad Kissingen, Bad Kissingen, Germany

9. Asarnusch Rashid
   Affiliation as printed

   ZTM Bad Kissingen, Bad Kissingen, Germany

10. Raphael W. Majeed Aachen Institute of Medical Informatics

    Universitätsklinikum Aachen · German Center for Lung Research · Universities of Giessen and Marburg Lung Center · RWTH Aachen University

    Affiliation as printed

    Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Giessen, Germany

    Institute of Medical Informatics, University Hospital RWTH Aachen, Germany