Tuesday, January 6, 2015

FHIR and the Future of Interoperability

There is growing interest in the health care information technology community in an emerging data exchange technology known as FHIR (pronounced “fire”). Last year we held a webinar on the topic with Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center; Keith Boone, Standards Geek at GE Healthcare; Janet Campbell, Software Developer at Epic; and Arien Malec, VP, Data Platform and Acquisition Tools at RelayHealth. Now I am following up with another great webinar (register for free HERE) with a great panel including Dr. Michael Hodgkins, CMIO of American Medical Association (AMA); Dr. Doug Fridsma, MD, CEO American Medical Informatics Association (AMIA); Dr. Charles Jaffe, CEO Health Level Seven (HL7); Jeffery Smith, Senior Director of Federal Affairs, College of Healthcare Information Management Executives (CHIME); and Mario Hyland, Senior Vice President AEGIS.net, Inc. You won't want to miss this...

FHIR, or Fast Health Interoperability Resources, is a proposed interoperability standard developed by the health care IT standards body known as HL7. Health Level Seven International (HL7) is a not-for-profit, ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing and retrieval of electronic health information.

Stakeholders from across the HIT ecosystem are actively exploring, experimenting and testing FHIR. Part of the enthusiasm surrounding FHIR is due to the elegant simplicity of the technology.

FHIR is attractive primarily because it is based on a truly modern web services approach (and one used by companies such as Yahoo, Facebook and Google). This approach makes it easier for systems to exchange very specific, well-defined pieces of information, rather than entire documents.

Such specific pieces of information might be as simple as a patient’s gender or marital status. Today in HIT, the common standard is one based on what is known as C-CDA, or Consolidated Clinical Document Architecture. And unfortunately, C-CDA is designed to transfer entire documents, rather than a single piece of data or a simple list.

This means that today, when a physician requests just one piece of information about a patient, the system often needs to transfer multiple documents to fulfill the request. This process can often be inefficient, because a physician may have to search through many pages of information to find just one piece of needed data.

FHIR, on the other hand, makes it simple for anyone to receive only, and specifically, the piece of information requested. FIHR also allows access to smaller or “granular” data elements that are not included in some clinical documents.

In sum, the proposed FIHR-based standard will make exchanging health care information faster and much more efficient.

The major technology change embodied in FIHR is a fundamental move away from a document-centric approach to a data-level access approach using application programming interfaces or APIs. Specifically, FHIR features a concept called “Resources,” meaning a very basic set of structured data.

For example, a resource could be defined as a medication list, a problem list or lab results. Already in today’s system, standard coding sets such as Logical Observation Identifiers Names and Codes (LOINC) for lab results, or RxNorm for medications, allow software applications to exchange just the data that is needed and present it in a highly meaningful way to clinicians or consumers. What FHIR offers is tools for developers to assemble and present many much smaller data elements to enhance the context or meaning of the information.

The consumer aspect is critical because the same technology can be used for patient engagement. FHIR will allow developers to access and use personal health care information to create innovative new apps. An app might be created to remind patients to take certain medications at the right time, for instance. The open Internet standards utilized by FHIR will make a personal health care “account” work much like any other secure app.

Read the rest of this post co-authored by Jean Doeringsfeld, COO of Wisconsin Statewide Health Information Network (WISHIN) on Government Health IT