Skip to main content

Your Hospital on FHIR


As a technologist, I am always skeptical when hearing about a brand new technology that is going to solve all of our current problems. I feel it is my responsibility to warn people about these types of promises.
Claims of “solving all healthcare information exchange (HIE) problems” are often being made about the emerging HL7 FHIR standard. According to Gartner’s hype cycle, the standard is at the “Peak of Inflated Expectations,” which I view as a stage where wishful thinking fills the gap created by a lack of knowledge and understanding.
FHIR, which stands for Fast Healthcare Interoperability Resources, is a draft standard from HL7 International. This standard is designed to be easier to implement, more open and more extensible than its predecessors, V2 and V3 standards.
So what’s the big deal here? Aren’t we simply replacing one transport protocol with another?
FHIR claims to bring a change in paradigm to the way health information can be accessed and consumed. Since FHIR is a RESTfull API, it allows access to the source of truth on demand and in real time. This capability has many advantages over the message-based, push-and-deliver model of other HL7 protocols.
Applications that build on FHIR do not have to copy and sync data from one system to another, a process that is often cumbersome and lengthy. There is no risk of data being stale, which is crucial in many clinical scenarios. Bi-directional communication, which was always a hassle in previous versions, is an integral part of FHIR. The fact that FHIR is an open standard (all documentation can be found on the web) and leverages modern web-based technologies such as HTTP/S, JSON, OAuth for authorization and ATOM for query results, means that most developers can adopt it easily.
Talk of FHIR includes all the right buzz words, but like any standard, it is just a tool, and the success of the tool depends on its adoption. So far, the adoption of FHIR has been quite remarkable. Although the current 3.x release is still defined as a “Trial Use Specification,” and only Release 4 is slated to include content that will be considered stable and ‘locked’, many of EHR vendors like Epic, Cerner, Meditech, eCW and iMDsoft announced their support for the standard. FHIR-based solutions have been piloted in many mobile health, pharma, precision medicine and public health sectors.
FHIR, however, faces the same challenges as the popular V2 messaging protocol: inconsistent implementations, multiple sub versions, and partial adoption by the community.
The FHIR standard is very broad and includes over 100 resources which are considered the core elements of healthcare. It covers not only clinical data but billing and payments as well. The patient resource, for example, supports animals and species. This wide coverage becomes a disadvantage when companies want to achieve complete adherence to the standard.
In order to mitigate these challenges, FHIR profiles, which are subsets of the standard with extended definitions, are being created. One particularly important profile is the Argonaut Project, which is a joint project of major US EHR vendors and hospitals such as Beth Israel Deaconess Medical Center and the Mayo Clinic. The INTEROpen group also provides clinical validation of FHIR profiles for use in the NHS and social care.
So what will the future HIE look like if everyone makes the switch to FHIR? What practical solutions will be available to care delivery organizations (CDO) in this new world that will truly make a difference?
In my opinion, the main benefit of FHIR is the ability to tap into a clinical repository on demand and interact with it. This capability brings interesting opportunities for mobile apps and other “add-on” products that can complement an enterprise EHR and that are sorely missing in today’s world. CDOs are looking to extract more value out of their expensive IT investments. FHIR has the potential to create an ecosystem of value-added products that EHR vendors are not willing or do not know how to provide. Startups and small companies are struggling to penetrate the market due to the complex and often costly integration work required.
On that note, it is important to mention the “SMART on FHIR” project sponsored by Boston Children’s Hospital. SMART, which stands for “Substitutable Medical Applications, Reusable Technologies”, is an open-source standard designed to enable “plug-in apps” to run natively inside any compliant EHR. SMART builds on FHIR and adds the necessary elements, such as context sharing and security, for developing clinical apps. In the SMART gallery there are already 41 apps, like nomogram and score calculators, that can supplement the capabilities of an enterprise EHR.
The issue of interoperability was solved in industries such as banking, airlines, and tele-communication, but we have yet to find a satisfactory answer for healthcare. Interoperability tears down the walls and allows innovation to flourish. FHIR meets the healthcare IT industry at a fortuitous moment. CDOs are starting to evaluate new technologies beyond what is provided by their EHR, such as predictive algorithms, machine learning, mobile access from any device, new decision-support methods, and real-time surveillance tools. Like PCs or smartphones, EHRs can become the platform for running all kinds of interoperable products, and the value of that interoperable ecosystem can surpass the value provided by the core platform.
FHIR still has a long way to go and many hurdles to overcome if it is to meet the high expectations of the HCIT community and fulfill the promise of seamless integration. At this point, I can only speculate about whether seamless integration will become a reality and when. If it does, however, I feel confident that FHIR will play an important role in that new world.

Comments

Post a Comment

Popular posts from this blog

Clinical data warehouses: Sometimes it's worth being lazy

If you are a health organization you probably have or thinking of having a clinical data warehouse. A Clinical Data Warehouse (CDW), sometimes called Clinical Data Repository (CDR), is a database that consolidates data from a variety of clinical sources to form a unified view of a the data for various purposes. Typical data types which are often found within a CDW include: clinical laboratory test results, vital signs, patient demographics, administered meds, hospital admissions, ICD-9 codes and more. Developing and sustaining an effective CDW operations unit is a substantial effort and long-term commitment. The main challenge in designing a CDW is defining its scope and the use cases it should support. In theory a CDW can serve as a basis for reporting, studying and planning. The use case that is often mentioned in relate to CDW is supporting clinical trials. This would allow for researchers to have all the information from a study in one place as well as let other researchers benefit
Post a Comment
Read more

Hospital CXO - A new well deserve seat at the executive table

I once asked the CEO of a large hospital what will be the main KPI to measure how well the hospital is doing. The CEO immediate response was that the best indicator would be how satisfy the patients are. In a stressful and overloaded environment such as a hospital, it is easy to focus on the disease and forget about the patient. A chief experience officers (CXO), or other similar titled leaders, is a new member in a hospital C-suite. The role of a CXOs have gained scope and respect in the C-suite as studies show how experience affects all aspects of care. There is a growing body of evidence supporting that the association between better patient experience and health care quality. For example, a study found that a higher CMS star rating was associated with lower patient mortality and readmission's.  One of the drivers accelerating the adoption was the US government decision to start mandate measuring patient’s perception of their care and tied reimbursement to those scores. Beyond t
Post a Comment
Read more

The case for PAA

PAA stands for Patient Admission App. In a nutshell it is a platform in which the hospital can communicate with its patients and their relatives before, during and after their stay in  the hospital. A patient's encounter with a hospital is often a traumatic event to both the patient and his family. A lack of  proper communication between the parties can have major implications on the hospital efficiency and the patient's experience which research shows has a critical impact on the quality of care. From red tape to red carpet  A PAA should accompany the patient throughout his journey by keeping him informed and engaged. This starts prior to the actual admission when the patient feels scared, anxious and confused. A PAA should provide the patient with all the information related to his upcoming treatment. This can include treatment reminders such as not to eat x hours before a planned anesthesia, orientation map, etc. It should also handle in advance al
Post a Comment
Read more