After a troubling experience witnessing the lack of coordination and sharing of data between providers in the care of his daughter, Shafiq Rab, M.D., vice president and CIO of Hackensack University Medical Center in New Jersey, was determined to do something about it. He set out to change the way Hackensack’s data is structured and standardized to pave the way for using Fast Healthcare Interoperability Resources (FHIR) standards to exchange healthcare information.
The 900-bed HackensackUMC is one of a few dozen early implementers associated with Project Argonaut, a key stakeholder in the HL7 FHIR standard’s development. The basic idea is to allow people to exchange granular data, not just documents and narratives that are difficult to process.
Rab said HackensackUMC has developed an application programming interface (API)-based infrastructure to eliminate care gaps and put the patient in control of their data.
“Our EHR is Epic,” Rab said. “The 2015 version will be FHIR-enabled, but we had the 2014 version and it is read-only. You can’t write to it. So we said, let’s find a way to FHIR-enable ourselves.”
“We decided to look for use cases for which we can create a secure, scalable and extensible FHIR-based system that can aggregate data from different systems,” Rab explained.
One of the use cases HackensackUMC is implementing involves the FHIR Draft Standard for Trial Use (DSTU) 2 Patient Resources to communicate with mobile devices. A mobile apps development team has developed an app that allows patients to send information to providers before appointments. Vendor partner Infor’s Cloverleaf integration engine technology is being configured at HackensackUMC to support FHIR pilots and proof of concepts.
“Cloverleaf is sitting in between their Epic EMR and the mobile app accepting and receiving FHIR resources,” said Ronald Archambault, director of software development at Infor. The mobile app sends a JSON-compliant FHIR resource to Cloverleaf; then Cloverleaf will transform that into the Epic API, send it and get a response back to the mobile app.
Archambault said FHIR is attractive because it allows organizations to send and receive smaller amounts of data. “For instance, a dentist doesn’t want anything more than they need, which may be just allergies and medications, so why consume an entire C-CDA? After looking at FHIR, we realized that this is the best approach.”
Rab said HackensackUMC also worked with a company called MphRx, which has developed both a novel way for patients to upload data to a clinical data repository that stores data as native FHIR objects. In a recent blog post, Varun Anand, a vice president at MphRx, explained the concept: The company’s platform exposes FHIR RESTful APIs and other healthcare standard-based interfaces to share this data with other clinical systems. “We don't transform data to comply with healthcare standards. We store them in a way that complies with the standard — a very subtle yet powerful difference in approach,” he wrote.
“The ultimate goal for me is to make interoperability possible so that there are no delays in health care,” Rab said. “We cannot rely on other people to make interoperability happen. This did not take us years to do. All you have to have is the will and the way to do it.”