Industry leaders see a landscape filled with complexity, when it comes to FHIR’s potential for facilitating rapid progress towards healthcare IT interoperability
Depending on whom you talk to, the U.S. healthcare system is either A) “totally on fire” with FHIR (the Fast Healthcare Interoperability Resources draft standard); B) awash with overblown hype on the potential for FHIR to transform the development of APIs (application program interfaces) in healthcare; or C) somewhere in between, with a mix of signals out in the landscape around the FHIR standard and around its potential to profoundly alter the course of the evolution of interoperability going forward.
And whether you tend towards A, B, or C, the reality is that a lot of developments have been advancing lately. For example, on Feb. 1, as Healthcare Informatics Senior Contributing Editor David Raths reported, “Standards organization HL7 has announced a collaboration agreement with the Healthcare Services Platform Consortium (HSPC), a provider-led nonprofit group working toward the development of an open ecosystem of interoperable applications, content, and service-oriented architecture (SOA) services.” As Raths reported, “HSPC’s vision is that, similar to iOS and Android, it will support a marketplace model for plug-and-play healthcare applications leveraging the work at Intermountain Healthcare, LSU Health, the VA VistA Evolution initiative, and others. The HSPC marketplace would support common services and models that providers and vendors could use to shorten development lifecycles.”
Meanwhile, very importantly, as Managing Editor Rajiv Leventhal reported on Dec. 14, the CommonWell Alliance and CareQuality, a division of The Sequoia Project, which is devoted to healthcare IT interoperability, announced on that date a set of agreements involving pushing forward into interoperability. Among other elements, CommonWell will become a CareQuality implementer on behalf of its members and their clients, enabling CommonWell subscribers to engage in health information exchange through directed queries with any CareQuality participant, while CommonWell and the Sequoia Project, CareQuality’s umbrella organization, plan to collaborate on connectivity efforts going forward.
So things are moving forward now, on a variety of levels. But what about the larger promise of FHIR in terms of U.S. healthcare eventually reaching true interoperability? There is a broad spectrum of views on that. “My view is that I welcome FHIR as a development; I think that anything that moves us away from the traditional handcrafted approach around APIs is helpful,” says Dave Levin, M.D., the former CIO of the Cleveland Clinic Health System and a partner in Amati Health, a Suffolk, Va.-based consulting firm. “I think it’s broadened the discussion, and I think the people involved have good intentions. I welcome that. I think there are some challenges, though,” Levin says. “I hear a lot of ‘happytalk,’ that this is the silver bullet that will fix everything,” and that is simply not realistic, he says. “I worry that expectations are too high. FHIR is a standard like others—a starting point, not a specification.”
What Does Geisinger’s Trial by FHIR Mean?
In that “starting point” assessment, Levin is joined by Alistair Erskine, M.D., CMIO of the Danville, Pa.-based Geisinger Health System. The experience that Erskine and his colleagues had recently with developing and then attempting to commercialize a FHIR-compliant app, demonstrates both the upside and the downside of the current FHIR-facilitated landscape, he says. Erskine and his colleagues invested time, effort, and funding into the creation of a rheumatology application. “We proved that we could use it on several different platforms,” he reports. “We tried to commercialize it, but got nowhere. There were two key problems. One, the various EHRs [electronic health records] weren’t really ready for a production-based mechanism. There was a lot of work the client had to do on their end to make it work; it wasn’t plug-and-play. Instead,” he says, “it was, build to plug, and do a lot of work to play. And while the app did something useful and helped us to take care of rheumatology arthritis patients, the colors, the buttons, and the feel weren’t harmonious with existing EMRs. So the informaticians and clinicians weren’t comfortable with having to teach end-users to use this.”
Alistair Erskine, M.D.
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