• 28 MAY 15
    • 2

    The FHIR Train Leaves the Station

    iHealthBeat by Ken Terry, iHealthBeat Contributing Reporter 

    Fast Healthcare Interoperability Resources (FHIR), a new standards framework from HL7, is starting to get traction in the industry as the latest focus of interoperability efforts. According to proponents of the rapidly evolving approach, FHIR promises to facilitate health information exchange, broaden the capabilities of electronic health records and accelerate innovation in mobile health applications.

    In essence, FHIR uses snippets of data known as resources to represent clinical entities within EHRs. Certain application programming interfaces (APIs), otherwise known as plug-ins, can connect applications to FHIR-enabled EHRs without customized interfaces. A security standard known as OAuth gives patients the ability to access the EHR data themselves or grant access to providers and others.

    FHIR has already gotten the attention of EHR vendors, some of whom are participating in the Argonaut Project. The coalition of 40-plus EHR suppliers, health care organizations and other stakeholders is implementing and testing the initial FHIR profiles. Among the EHR developers participating in the project are:

    • athenahealth;
    • Cerner;
    • Epic;
    • GE;
    • McKesson;
    • Meditech;
    • NextGen; and
    • Practice Fusion.

    David McCallie, Jr., senior vice president of medical informatics for Cerner, said these vendors are expected to “go into production” on a subset of FHIR profiles within the next six to 12 months. “Hopefully, they’ll all implement these core services for things like problems, medications and allergies,” he said

    EHR developers are taking notice of FHIR partly because the government might make it mandatory, McCallie noted. In the meaningful use Stage 3 proposal, CMS advocates for an “open API” that would allow patients to view, download and transmit their own EHR data. Although FHIR is not mentioned, the Office of the National Coordinator for Health IT cited FHIR several times in its 2015 EHR certification proposal.

    The FHIR standard was recently coupled with another innovation designed by researchers at Harvard Medical School and Boston Children’s Hospital — the Substitutable Medical Applications and Reusable Technology platform. SMART provides a Web-based graphical user interface to FHIR, using software written in HTML5 and Javascript. The combined programming is known as SMART on FHIR.

    An app developer could write an app to SMART on FHIR specs and would be able to connect it to any FHIR-enabled EHR. What this means is that consumers could select SMART on FHIR apps from outside firms and plug them into their provider’s EHR.

    Clearly, this would be an enormous spur to innovation among the nation’s app developers.

    CCDA Replacement?

    Currently, the only way to exchange care summaries between disparate EHRs is to use the CCDA, a document that follows another HL7 standard. But some EHRs are unable to exchange these care summaries because the standard is complex and allows too much room for variations. FHIR could provide a way to escape this dilemma by allowing discrete data to be exchanged directly instead of as part of a document.

    The Argonaut Project is now focusing on a subset of FHIR that consists of the 16 data elements in the CCDA. Chopra said these components have been trimmed to 12 FHIR profiles. The Argonauts are testing these profiles and creating open-source implementation guides for them. “What FHIR proposes to do is to make it much easier to exchange and use the individual data elements,” he said.

    . . .

    Expanding EHR Capabilities

    EHR developers provide the core capabilities of EHRs and associated financial systems, “but we can’t build everything that users need or want,” McCallie said. “So the [FHIR-enabled] apps will open that up for extensions in ways that go beyond what the vendor had focus or interest or time to provide.”

    These apps might add new functionality to the EHR or they might enable EHR users to import additional data from other sources. For example, an accountable care organization might be able to provide a “population view” to a physician who participates in the ACO through a specialized app, McCallie said.

    . . .

    Future of Interoperability

    In the long run, Chopra said, FHIR could solve the technical problems of EHR interoperability. But business, legal and policy issues will continue to impede the flow of information, he predicted. The key to effective data sharing, in his view, will be the right of the patient to his or her own data.

    “Whether the government forces hospital A to share data with hospital B or not, if they can both speak FHIR to the patient, the data become liquid and can be exchanged safely and securely through the patient,” Chopra said.

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