HL7 FHIR-Based Open-Source Framework for Real-Time Biomedical Signal Acquisition and IoMT Interoperability

This study presents the design and validation of an open-source framework for biomedical signal acquisition and interoperable data exchange based on the Health Level Seven—Fast Healthcare Interoperability Resources (HL7 FHIR) standard. The proposed system enables secure, wireless transmission of physiological data from distributed sensing nodes toward a locally hosted monitoring platform. The hardware architecture integrates ESP32-WROOM-32 microcontrollers for multi-parameter acquisition, the MQTT protocol for low-latency communication, and a Home Assistant (Nabu Casa, San Diego, CA, USA)–InfluxDB (InfluxData, San Francisco, CA, USA)–Grafana (Grafana Labs, New York, NY, USA) stack for real-time visualization. The novelty of this work lies in the full-stack implementation of HL7 FHIR Observations within a reproducible, open-source environment, ensuring semantic interoperability without reliance on proprietary middleware or cloud services. A case study involving multi-sensor acquisition of electrocardiographic (ECG), photoplethysmographic (PPG), temperature, and oxygen saturation signals was conducted to evaluate system performance. Validation results confirmed consistent end-to-end data flow, sub-second latency, zero packet loss, and accurate semantic preservation across all processing stages. These findings demonstrate the feasibility of implementing standardized, open, and scalable biomedical Internet of Medical Things (IoMT) systems using non-proprietary components. The proposed framework provides a reproducible foundation for future telemedicine and continuous patient-monitoring applications, aligning with FAIR data principles and the ongoing digital transformation of healthcare.