In August, the Indianapolis-based Regenstrief Center for Biomedical Informatics announced that it was piloting the use of the Fast Healthcare Interoperability Resources (FHIR) standard to merge data from individual electronic health records (EHRs) with those stored in the Indiana Network for Patient Care (INPC), Indiana's common framework for health information exchange (HIE).
In the press release at the time from Regenstrief, a medical and public health informatics research organization that has been at the core of health IT innovation in the Indianapolis region for 40 years, officials brought up the following question: “You are rushed to a hospital in an emergency, is your complete medical record available to those caring for you? Will they know all medications you have been prescribed and whether you are taking them as directed? Does your primary care physician know your complete medical history?” Indeed, according to clinician-informaticians of the Regenstrief Institute, the answer to these questions is almost always "no." Not having complete health information available often results in subpar care and can endanger patients.
To this end, healthcare technology innovators and developers have pointed to SMART (Substitutable Medical Applications & Reusable Technologies) on FHIR implementing an open architecture to support interchangeable developer-friendly APIs (application program interfaces) that can be “plugged in” to any compliant EHR or health data container. Part of the allure is that the effort can get away from document-centric approaches and expose discrete data elements as service.
Enter this FHIR pilot, and with it, Titus Schleyer, M.D., Ph.D., a Regenstrief Institute investigator and Clem McDonald Professor of Biomedical Informatics at Indiana University School of Medicine, who is at the center of this project. "Imagine that you as a patient can use an ‘app’ on your smart phone to reconcile the multiple lists of medications maintained by several care providers into one authoritative, current list. And then, you can bring that list to your colonoscopy screening appointment for review by your physician prior to the procedure. That is huge, which is why the federal government is also focusing attention on helping patients do that,” Schleyer says, speaking to FHIR’s benefits.
Schleyer says it was about three years ago when Graham Grieve, the co-creator of the FHIR standard, approached Regenstrief about its potential. What happened next? What will the pilot look to accomplish? And what’s in store for FHIR’s future as a healthcare standard? Schleyer discusses this and more in the below interview with Healthcare Informatics.
What are the main details behind this project’s conception?
FHIR is not really an established standard; it’s kind of young. About three years ago, Graham Grieve said that it would have a very different dynamic than most other healthcare standards. He asked if Regenstrief would support it. We signed off on it, and while I have been in healthcare standards for 25 years, there’s a different flavor to FHIR when compared to other stuff. It was a risky decision for me, but in the past three years I have not seen anything in the healthcare standards [space] that has moved as fast and has moved with such great dynamic as FHIR has. It has “legs.” So how can we solve some of the longstanding interoperability and information aggregation problems using this new standard? That’s where the pilot came in.
Why was it a risky decision for you?
You never want to be the person who bets on the next Betamax. I was alive when that went down, and you heard stories about how VHS won against Betamax despite not being a superior technology. So you have to look at these new developments and wonder if you are betting on what will be there in five years. You do have to educate yourself about the technology and the approach, and you build stuff on top of it. During my life I have done a few things where I bet on computer technologies that I thought were great and a few years later the company that made the tool was out of business. But as I talked to Graham and other early developers, it was evident that FHIR had a quality user-centered design, which means you design something with the user in mind, getting in the head of how they operate and think.
What else about FHIR sold you?
With versions of HL7 Reference Information Model (RIM), you needed this huge level of expertise and you had implementation guides that ran thousands of pages, but FHIR didn’t have that look and feel to it. When we did this pilot in April, there was a “Connectathon,” in which 17 teams from the Indianapolis area, many of them having their first exposure to FHIR, were gathered together to [run demos] on it. I was in the room with the developers for two days, and by the end of the weekend these people were doing stuff that was really cool. With HL7 RIM, you’d have to lock these same people in a room for six months before they would have produced something on that model. It was amazing to see these 17 teams all turn out something that worked by the end of the weekend. So I thought, if the uninitiated can work with FHIR so quickly, it will be a winner.
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