The upcoming FHIR DevDays meeting in Boston June 19-21 brings together the community of health IT executives working on implementing the HL7 interoperability standard. The agenda provides a snapshot of progress on several fronts. I asked Wayne Kubick, HL7’s chief technology officer, for a preview of seven presentations that sounded intriguing.
• IHE Profiles and FHIR. In a very new development, HL7 has been talking to IHE (Integrating the Healthcare Enterprise) about a new project, code-named Gemini. “We have agreed to collaborate to try to encourage the use of FHIR in IHE profiles and exchange knowledge and information, but we haven’t formalized it yet with a charter,” Kubick said. “It is in a very early stage. Our missions and visions are similar. We have complementary strengths. Seeing the benefits FHIR can offer for interoperability, IHE wants to get on board, too, and get it embedded in IHE installations around the world.”
• Devices on FHIR. HL7 notes that for decades accessing information from healthcare devices has been both challenging and expensive. Todd Cooper, who has a background in standards-based medical device informatics and co-founded the HL7 Health Care Devices and IHE Patient Care Devices groups, will describe the progress so far on the Devices on FHIR (DoF) initiative – a collaborative effort between HL7, IHE & PCHA – to leverage FHIR to make the exchange and use of device-sourced content just as simple as any other type of information. Cooper launched the Devices on FHIR initiative in the summer of 2016 and serves on the HL7 FHIR Foundation Board.
“It makes perfect sense for device interoperability to use FHIR more extensively than it is right now, but they are moving kind of slowly,” Kubick admitted. “It hasn’t move quite as quickly as we would like. It comes down to getting the direct engagement from device manufacturers, who aren’t quite embracing the promise of interoperability as much as they could yet.” The Devices on FHIR initiative is looking at how they can use the power of the FHIR specification to streamline device interoperability and make it more common between all kinds of devices. “We have a lot of specialized APIs in place today,” Kubick said, “so that is the conflict we have in the devices world. I don’t think we have achieved the traction and maturity we want to see. We expect it will happen soon enough.”
The technology has been successfully demonstrated at three connect-a-thons — proofs of concept connecting different types of devices, so the technology isn’t really the limitation, Kubick explained. “It is pretty obvious the benefit of a common API, especially one that is also used for other types of health information. We went through a similar thing with EHR vendors. They developed custom APIs and have been migrating to FHIR. It has been great, but it took a while to do that. You have a sunk cost fallacy. It is hard to justify it until you have enough momentum to carry it along, which is what the Argonaut Project achieved in the EHR world. We don’t quite have an Argonaut in the device world yet, but we are hoping that will come up.”
• Argonaut Projects. There will be a few sessions describing Argonaut projects at FHIR DevDays. One session will provide an overview of Argonaut initiatives: Provider Directory, Scheduling, Data Query, Document Query. Another will go in-depth on the FHIR Version 3.0.1 based Argonaut Scheduling Implementation Guide use cases and operations for searching for availability, holding, booking, searching, and cancelling appointments by both patient- and provider-facing applications. It will review the early adopt experience, challenges and future steps.
Concerning Argonaut, Kubick said the big splash came a few years ago with the Data Access Framework, the original Argonaut implementation guide, which was the fundamental building block for common APIs from the EHR system. “That one was big,” he said. The subsequent projects they have done have been more tailored and focused. The same year they published the DAF implementation guide, they also published the provider directory, but it wasn’t quite as visible, he said. In year two, they did Scheduling and the CDS Hooks piece. (CDS Hooks is an emerging standard that leverages both FHIR and SMART to provide open and interoperable decision support in the EHR.) “CDS Hooks is really a transformative technology that may be premature for being widely adopted yet,” Kubick said. “But to be able to have an underlying technology to actually sit within the EHR system, be aware of events, and trigger actions is a huge component for clinical decision support.”
At FHIR DevDays, Kevin Shekleton, a vice president and distinguished engineer at Cerner, will lead a session on CDS Hooks. He will demonstrate how you can use it to provide guidance to the clinician such as a better medication to order, critical information about the patient, or push a SMART app that should be run.
In year three, Argonaut is focused on three main projects. One focuses on unstructured Clinical Notes. It involves taking the unstructured information buried within the EHR and being able to encapsulate it and present it through the API. “Not only can you get structured information about a patient, such as their medications, but also collect the contextual notes that the clinicians have entered and is really important,” Kubick said. “That is very important to the Office of the National Coordinator. It extends the flexibility and scope of what you can get out of an API.”
Another huge piece is Bulk Data Export, which will support value-based care, analytics and quality of care by being able to send a collection of data for an entire population, so that would include public health activities. As HL7 notes, today bulk export is often accomplished with proprietary pipelines that are difficult and expensive to maintain. Josh Mandel and Dan Gottlieb of Boston Children’s Hospital will present on a new effort by SMART and HL7 to bring the FHIR standard to bear on these challenges of bulk-data export.
• The Da Vinci Project is a multi-stakeholder effort led by payers, providers and HIT vendors to address use cases in value-based care. “They have a project manager and a technical lead,” Kubick said. “They are having a kickoff meeting right after the DevDays meeting in Boston. They have identified use case and are planning to move quickly.” One initial use case involves 30-Day Medication Reconciliation Post-Discharge. Viet Nguyen, M.D., chief medical officer for the Health Services Platform Consortium, will give an overview of the project.
Finally, in one keynote speech, Google’s Eyal Oren’s with talk about how FHIR lies at the core of the information infrastructure of Google Brain in healthcare.