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FHIR, the hottest topic at HIMSS16, sets stage for population health

CMS, ONC promise to not only accelerate adoption of the interoperability spec but also have some providers looking ahead at ways they can put it to use.
By Tom Sullivan
08:26 AM
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FHIR advocate HL7 put a lot of evert into marketing the interoperability spec at HIMSS16. (Twitter photo)

The emerging protocol known as FHIR has been most closely associated with interoperability so far. The acronym, after all, stands for Fast Healthcare Interoperability Resources. But if the standard succeeds in its mission of enabling widespread data exchange, FHIR might soon have a higher calling to serve as a foundation for population health management.

"FHIR is a better-designed Lego," said Doug Dietzman, executive director of Great Lakes Health Connect, a self-sustaining health information exchange in Grand Rapids, Michigan. "I'm looking forward to having it in my toolbox."

Feds back FHIR, big-time

There is certainly no lack of public support for FHIR right about now. National coordinator Karen DeSalvo, MD, started the fire at HIMSS16 by launching a $625,000 triptych of developer challenges. One focuses on patient-facing apps, the second on software geared toward providers and for the third ONC is hoping the funding and recognition inspire someone to create what essentially would be an app store for housing these FHIR-based apps and making them available for download.

[Also: See our big gallery of HIMSS16 photos]

DeSalvo described the developer challenges as an opportunity for the federal government to engage private sector entrepreneurs in building technologies that make more effective use of health data for patient-centric care.

"It's time for us to see some digital dividends," DeSalvo said, "to really make that data sing."

That's going to require much more than these developer challenges. In fact, DeSalvo's announcement came just days after ONC unveiled the Interoperability Proving Ground, which the director of ONC's office of standards and technology, Steve Posnack, called a "Match.com for FHIR."

As of March 10, there are currently 61 projects in the Interoperability Proving Ground. While those are not limited to FHIR, the idea is to build a central hub that connects the community of people working on interoperability projects to share lessons learned, best practices and, indeed, to prove the progress already being made.

The MITRE Corp., meanwhile, also used the occasion HIMSS16 to post an open source tool, a web UI called Crucible. Available at ProjectCrucible.org, it enables developers to run 228 test suites comprising some 2,000 tests of the FHIR specification. Entrants are classified as API, resources or administrative, displayed in a graphical map to pinpoint bugs and, ultimately, given a pass or fail grade. 

[Also: Poll: Which health IT trends dominated the conversation at HIMSS16?]

MITRE lead systems engineer Andre Quina cut to the chase: "Having a standard alone isn't enough to achieve interoperability," he said. "Ambiguities in the standard can be disastrous."

Nascent progress en route to population health

Among the early success stories of FHIR in action is the work Duke School of Medicine is doing with FHIR and Apple's HealthKit to integrate standards-based apps such that it can, in the words of Duke's director of mobile technology strategy Ricky Bloomfield, MD, "liberate electronic health records data."

Another perhaps less-covered initial FHIR success is the rheumatology app that Geisinger Health System's innovation unit xG Health Solutions built with FHIR to communicate between Epic and Cerner EHRs basically straight out-of-the-box.

Duke and Geisinger's work offers a glimpse into the much larger potential FHIR holds. 

Indeed, at Great Lakes Health Connect, Dietzman is already thinking about the big picture — as is Corey Waller, MD, medical director at the Spectrum Center for Integrative Medicine, which participates in the Great Lakes HIE.

Hurdles ahead 

Dietzman and Waller acknowledged that FHIR alone won't get the nation to ubiquitous population health management, of course. No single technology or specification existing today can manage that.

Many in the industry, rather, maintain that technology is not the hardest obstacle. Healthcare organizations haven't received strong guidance from the government, Waller said, while Dietzman added that issues such as informed consent and compliance with federal mandates are also inhibiting information exchange.

[Also: Duke liberates Epic EHR data with Apple HealthKit and FHIR]

That said, what FHIR at least has the promise of enabling is something akin to a reliable pathway into data about patient populations.

Waller said he can envision looking at patient records relative to a particular geography to know in which neighborhood to set up, say, an addiction clinic. And that's just one example.

"I can only imagine what we'll be able to do when we have that data," Waller said. "I know I have the keys to a healthier community. I just can't use that data effectively yet."

Twitter: @SullyHIT


This story is part of our ongoing coverage of the HIMSS16 conference. Follow our live blog for real-time updates, and visit Destination HIMSS16 for a full rundown of our reporting from the show. For a selection of some of the best social media posts of the show, visit our Trending at #HIMSS16 hub.