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Top Ten Tech Trends: In This Election Year, the Marketplace is Voting for FHIR

March 21, 2016
by David Raths
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Public- and private-sector forces are coalescing around the idea of offering granular access to data through application programming interfaces

Healthcare Informatics chose HL7’s FHIR (Fast Healthcare Interoperability Resources) standard as one of its top 10 Tech Trend topics in both 2014 and 2015, and we see no reason to drop it from the list this year.

As proponents have noted, the combination of FHIR for content summaries and the REST standard for transport would bring healthcare into alignment with the more modern web services approach used by companies such as Yahoo, Facebook and Google, making it easier to find developers who can jump right in and create solutions in healthcare.

Geisinger Health System (Danville, Pa.) chief clinical informatics officer Alistair Erskine, M.D. compares the concept to a vendor-neutral archive for imaging. “We’d have a vendor-neutral app store for EHRs and portals, he says. “A developer, whether they have a relationship with a vendor or not, could develop apps and use FHIR to communicate with the various databases without having to rewrite their software each time. Also, people are saying, ‘I don’t want to have to write my thing in Epic or Cerner. I want to write it in Python, PHP, or Java and use data services to attach it to the big monolithic system of record.’”

Geisinger is one of the pioneers in creating FHIR-based apps. Geisinger’s IT team took less than a month to embed a rheumatology app within its Epic system and FHIR-enable it to run across Cerner’s and athenahealth’s systems, without having to be re-written. Although they proved the feasibility of doing that, Erskine did have a word of caution: As health systems try to deploy the app in other settings, the EHR vendors don’t yet support all the FHIR resources that the rheumatology app needs, so they have to find some adapter or middleware between the EHR and the app.

Erskine says that to some degree, the vendors are reluctant because the FHIR framework upsets their current business model. “If they drag their feet and wait a few years before providing APIs that are comprehensive enough to be useful, the market will respond with alternative solutions,” he says. Companies such as Sansoro Health are popping up to provide FHIR services, and interface engine companies are supporting FHIR in their latest versions, he notes.

Blue Button on FHIR

The federal government is getting in on the FHIR action, too. Mark Scrimshire, an entrepreneur-in-residence at the Department of Health and Human Services, is on a team working to turn the Blue Button Medicare download solution into Blue Button on FHIR. Blue Button has only been available as a PDF or text file. The project team is building an interface on top of the FHIR API to enable Medicare beneficiaries to connect their individual claims information to third-party applications they trust. Once connected, the third-party application can pull their data without requiring further effort from the beneficiary. Those third-party developers could be new personal health record (PHR) companies, Scrimshire says, but they could also be accountable care organizations or forward-thinking hospitals that want a better relationship with patients.

Attempts to develop personal health records, such as that by Google Health, didn’t take off because it was so hard to get the data, he says. “This is part of an overall push to get the data in the hands of consumers. It doesn’t mean that they have to do the heavy lifting. That is what we are doing with Blue Button on FHIR. It is taking the beneficiary out of the business of getting their data where they want it to go.” He said that although CMS will only be publishing claims-related data, “there is nothing stopping someone from taking the open source implementation we are building for the Blue Button front end and putting it on top of a hospital’s FHIR server that happens to have a lot of clinical data.”

Charles Jaffe, M.D., HL7’s CEO, says that perhaps the chief misconception about FHIR is that it is just a draft standard and not ready for implementation. “On the contrary, we have about 150 vendors and business organizations around the world who have committed in writing or in dollars and cents to making this happen,” he notes. “We had a conference call with the HL7 advisory council only [recently] in which the leadership from Epic and Cerner reiterated their commitment to specific deliverables of the Argonaut Project. So to the CIOs I say this is an enormous opportunity, because there are problems waiting to be solved, and all the tools are here and free with terrific technical support of a product that is remarkably easy to use.” He notes that universities are getting onboard. Georgia Tech now requires the development of a FHIR app as part of an undergraduate course. “It would be shortsighted to think this needs to be cited in regulation to make it happen,” Jaffe says. “The marketplace has already decided that this is more than simply viable. It is transformative."