FHIR and the future of interoperability

By Brian Ahier
08:03 AM
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There is growing interest in the health care information technology community in an emerging data exchange technology known as FHIR (pronounced “fire”).

FHIR, or Fast Health Interoperability Resources, is a proposed interoperability standard developed by the health care IT standards body known as HL7. Health Level Seven International (HL7) is a not-for-profit, ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing and retrieval of electronic health information.

Stakeholders from across the HIT ecosystem are actively exploring, experimenting and testing FHIR. Part of the enthusiasm surrounding FHIR is due to the elegant simplicity of the technology.

FHIR is attractive primarily because it is based on a truly modern web services approach (and one used by companies such as Yahoo, Facebook and Google). This approach makes it easier for systems to exchange very specific, well-defined pieces of information, rather than entire documents.

Such specific pieces of information might be as simple as a patient’s gender or marital status. Today in HIT, the common standard is one based on what is known as C-CDA, or Consolidated Clinical Document Architecture. And unfortunately, C-CDA is designed to transfer entire documents, rather than a single piece of data or a simple list.

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This means that today, when a physician requests just one piece of information about a patient, the system often needs to transfer multiple documents to fulfill the request. This process can often be inefficient, because a physician may have to search through many pages of information to find just one piece of needed data.

FHIR, on the other hand, makes it simple for anyone to receive only, and specifically, the piece of information requested. FHIR also allows access to smaller or “granular” data elements that are not included in some clinical documents.

In sum, the proposed FHIR-based standard will make exchanging health care information faster and much more efficient.

The major technology change embodied in FHIR is a fundamental move away from a document-centric approach to a data-level access approach using application programming interfaces or APIs. Specifically, FHIR features a concept called “Resources,” meaning a very basic set of structured data.

For example, a resource could be defined as a medication list, a problem list or lab results. Already in today’s system, standard coding sets such as Logical Observation Identifiers Names and Codes (LOINC) for lab results, or RxNorm for medications, allow software applications to exchange just the data that is needed and present it in a highly meaningful way to clinicians or consumers. What FHIR offers is tools for developers to assemble and present many much smaller data elements to enhance the context or meaning of the information.

The consumer aspect is critical because the same technology can be used for patient engagement. FHIR will allow developers to access and use personal health care information to create innovative new apps. An app might be created to remind patients to take certain medications at the right time, for instance. The open Internet standards utilized by FHIR will make a personal health care “account” work much like any other secure app.

An ‘app store’ approach
In addition to offering the means to exchange healthcare data in much more granular pieces than ever before, FHIR is also easy for software developers to work with, which could prove to be a big boon to innovation.

These technical capabilities provide the opportunity for a plug-and-play platform that is conceptually similar to the Apple app store. FHIR would allow developers to create new and innovative apps by using the Public APIs and following a well-defined set of rules. In this sense, the interface represents a true app store approach to healthcare data and interoperability.

Today, many software vendors build their own APIs to share data with specific applications. Most vendors, however, would likely embrace a Public API offering a unified approach to share data with any application. This enables plug-and-play capability between systems, not just within systems. The ability of this interface to exchange data with any software using a Public API can foster an ecosystem of interoperability among health IT systems.

Current and future market needs
Health industry leaders and policy makers are increasingly focused on driving greater interoperability between and among health IT systems. That is, as value-based health care models expand, both payers and providers need secure ways to better connect and exchange analytics and information. 

This particular opportunity is sometimes overshadowed in the discussion of FHIR. The uses of Public APIs are not solely for EHR vendors — HIEs can and should leverage Public APIs in order to expand their use cases. Indeed, a key issue for statewide HIEs will be leveraging the new Public APIs to support value-added services for their communities.

FHIR squarely attempts to address these business needs, both by leveraging existing technologies in an easy-to-use and readily replicable “app-like” environment, and by providing truly granular data-level access as a step forward from today’s document-based exchange architecture.

FHIR keeps common scenarios simple and attempts to provide more seamless connectivity standards. The proposed standard represents a smarter way to use technology by building on what is already in place while also providing the flexibility to meet future business needs. FHIR is not simply adding additional standards to an already overflowing kettle, but rather the next step in the evolution of standards that will truly promote interoperability.

FHIR a possible standard?
The Office of the National Coordinator JASON Task Force and others have made recommendations to the ONC to establish and maintain a set of public API standards. Assuming ONC follows the recommendations, EHR vendors would be required to use those Public APIs to obtain certification. If FHIR were to be designated as the Public API, the implications are far-reaching.

FHIR technology represents a major opportunity to accelerate health care data interoperability across a wide range of currently disparate systems.

Ultimately, FHIR may become a critical technology driver for increasing health care quality, increasing patient access and use of health information and improving outcomes.

See also: 

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