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At iHT2-Cleveland, Micky Tripathi Offers a Nuanced View of FHIR and Its Transformative Potential

April 27, 2016
by Mark Hagland
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The Massachusetts eHealth Collaborative’s Micky Tripathi shares his perspectives on the promise and pitfalls of working with FHIR

With the journey towards interoperability turning out to be a very bumpy ride in U.S. healthcare, many in the industry are pinning at least some of their hopes on the adoption of the FHIR (Fast Healthcare Interoperability Resources) standard, a standard that has begun to get real traction of late.

The subject of FHIR came up during a session on interoperability on Wednesday, Apr. 20, at the Health IT Summit in Cleveland, sponsored by the Institute for Health Technology Transformation (iHT2, a sister organization to Healthcare Informatics under the Vendome Group, LLC umbrella). The panel, entitled “Interoperability & HIE: Strategies for an Evolving Health System,” was moderated by Mark W. Stevens, principal at ARRAHealth Consulting, Inc., and included as its other panelists John Santangelo, senior director, information technology, at Cleveland Clinic Florida; Kerry McDermott, vice president, public policy, for the Center for Medical Interoperability; Jitin Asnaani, executive Director of the CommonWell Health Alliance; and Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative.

During the panel discussion, when asked about FHIR, Tripathi said that “There are reasons to believe FHIR could help us. My caution: it is still a very nascent, primitive standard; it’s just a technical standard,” he added. “There are business, legal, and cultural issues. I don’t think we should kid ourselves and believe that a new standard will fix everything. But FHIR does democratize to help us move to the next level,” he continued. “It is based on the same types of interoperability processes in other industries. Other industries see healthcare as a backwater that they would never want to get involved in, because we use moribund standards from about 1985. FHIR is based on principles and basic Internet patterns that Facebook, Google, Amazon, Uber, are using. So there’s a democratizing aspect of it, so developers will start to come into the space as we move forward with it.”

Micky Tripathi

Tripathi went on to say of FHIR, “Also, it’s a true data-level standard. Right now, we’re exchanging continuity of care documents, which is important, but you’re not able to get to the next level, app engagement, until you have true data-level standards, and FHIR does that. So at Argonaut, we’re saying, let’s have this as a workable standard and build on that. There’s a lot of FHIR hype, which is both good and bad.”

Immediately following the conclusion of that panel discussion, HCI Editor-in-Chief Mark Hagland sat down with Tripathi and asked him to elaborate on his comments during that discussion. Below are excerpts from that interview.

I really appreciated your comments in the panel discussion. Can you frame for me at a high level how you perceive FHIR right now, in terms of its potential to help transform the path forward towards healthcare IT interoperability?

Speaking first to the opportunity side, I’ll discuss why you should be excited about FHIR. When you talk to developers from other industry verticals, they’re wondering, first, where are all the technologists in healthcare? They’re really surprised. And that’s because, I think, we have these very arcane, old standards that are cumbersome. I was in Silicon Valley in the fall, at a conference sponsored by [the Palo Alto, Calif.-based] Venrock, one of the VC [venture capital] firms. And a guy said, ‘I downloaded a guide that was over 1,000 pages on CCD [continuity of care document] and other types of document exchange! And we work with APIs [application programming interfaces] are one-offs, and that can be developed in, like a month. And is this like hieroglyphics?’

So the opportunity is that FHIR is based on a set of Internet principles like RESTful API [which stands for “representational state transfer API”] that people use every day. So that’s the opportunity; it’s something more aligned with the way the rest of the economy works. And that will be an opportunity for developers to come in. It will be the crowdsourcing phenomenon. They’ll bring fresh eyes and new use cases. And then that will enable me to exert real demand on vendors. Because right now, how do I get my data, as a patient? Now all of a sudden if there’s an API I can download from somewhere, that gives me the opportunity as a consumer to exert leverage.

The concern about the hype is this: KLAS [the Orem, Ut.-based KLAS Research] did an interoperability study in the late fall. And one of the things they asked providers was, what do you think will be the biggest opportunity and hope for interoperability in the future? And FHIR was number one. And I’m going to bet you that 90 percent of those people don’t really know what FHIR is. In working with FHIR, I still have to figure out the trust issues—legitimate security and privacy issues—how do I know that you’re authorized, from a HIPAA [Health Insurance Portability and Accountability Act] perspective, to interact with my data? A standard doesn’t solve those issues. Those are business and legal issues.