Primary-care linkage
Warm-handoff protocol: roles, triggers, and shared documentation between discharge and longitudinal primary care.
Phase 2
Coming in Phase II
FHIR R4 · v0.1.0 draft · CC‑BY 4.0
Interoperability for heart failure care where there’s no cardiologist.
An HL7 FHIR R4 Implementation Guide that makes the peer-reviewed HEARTLAND Protocol implementable inside any US EHR. Profiles for risk assessment, care plans, and remote monitoring — bound to LOINC, layered on US Core, ready for vendor pilots.
For licensed clinicians and EHR implementers. Not a medical device, not FDA-cleared, not HIPAA-certified. Examples are synthetic; no PHI is included.
Why this IG exists
The protocol is published. The EHR pieces are not. This IG is the bridge.
86%
of rural counties
have no practicing cardiologist.
+53%
excess HF mortality
in rural communities versus urban.
< 1%
of patients
reach all four GDMT therapeutic targets.
GWTG-HF and ESC-HF-LT are registries. MAGGIC and SHFM are prognostic calculators. None ships an EHR-implementable specification of the rural HF workflow. This IG does.
What’s inside
Eight protocol modules, twenty-seven FHIR resources.
Each module of the published HEARTLAND Protocol maps to one or more FHIR R4 conformance resources. Profiles, extensions, value sets, code systems, questionnaires — all generated from FSH source via SUSHI and the HL7 IG Publisher.
Risk stratification
Ten-variable HEARTLAND score including distance to cardiology and social support — variables MAGGIC and SHFM omit.
RiskAssessment + Questionnaire
Defined in v0.1.0
GDMT optimization
Four pillars (ARNI/ACEi/ARB · BB · MRA · SGLT2i) with tier-specific cadence encoded as CarePlan activities.
CarePlan profile
Defined in v0.1.0
Telephone titration
Track A (digital, app-based) vs Track B (analog, telephone). Identical clinical algorithms; choice reflects patient access.
MonitoringTrack code system
Defined in v0.1.0
Discharge transitions
Three condensed (Tier 1) or eight AHA-aligned (Tier 2/3) education domains as CarePlan activities.
CarePlan activity catalog
Defined in v0.1.0
Remote monitoring
Weight, BP, SpO2 with red-flag thresholds via referenceRange. Human filter before ED escalation.
Observation profile + LOINC
Defined in v0.1.0
Comorbidity context
Patient profile carrying distance-to-cardiology and social-support extensions surfaced by the risk score.
Patient profile + 2 extensions
Defined in v0.1.0
Implementation tier
Facility self-assessment Questionnaire that returns Tier 1 / 2 / 3 with a tier-shaped CarePlan activity set.
FacilityTierQuestionnaire + ext.
Defined in v0.1.0
Current state
Where the IG stands today.
v0.1.0 is a draft release intended for vendor review and pilot site evaluation. Cleared SUSHI compilation and HL7 IG Publisher QA with zero critical errors.
| Cureus manuscript | Published; peer-review response in progress |
| HEARTLAND Protocol | v3.2 (Feb 2026) — authoritative |
| FHIR IG | v0.1.0 — initial draft, ready for vendor review |
| Zenodo IG DOI | Pending — minted at first public release |
| Pilot site EHR validation | Phase 3 — not yet started |
Open science
Citable across every layer.
The protocol, this IG, the companion app, and three systematic reviews share an open-science footprint. Every artifact has a persistent identifier.
ProtocolCureus (peer-reviewed)indexed PubMed · PMC · Scopus · Google Scholar→ProtocolZenodoDOI 10.5281/zenodo.18566403→ProtocolOSFDOI 10.17605/OSF.IO/YUSGH→FHIR IGGitHub sourcevickymuller-md/heartland-fhir-ig · v0.1.0→
FHIR IGZenodo (this IG)Pending first public release · CC-BY 4.0
Companion appapp.heartlandprotocol.orgEight interactive modules · MIT→