As a promising solution to the challenge of healthcare interoperability, FHIR threads together all the pieces of a patient’s story to allow for a more comprehensive and detailed point of care. With internet-based consumer experiences becoming the new global standard, healthcare systems are looking to adopt this new practice…and it’s spreading like FHIR.
“It’s not a data problem. It’s a filter problem. Physicians want data, but they want it presented in a way that is useful and actionable for them.”
– Dr. Nick van Terheyden, Chief Medical Officer, Dell
FHIR has the potential to counter major obstacles in healthcare like:
- Enhancing patient engagement
- Population health management design
- Promoting robust care management
- Valuable insights at point of care
Origins of FHIR
In 2014, Health Level Seven (HL7) crafted FHIR (the Fast Healthcare Interoperability Resource, pronounced like ‘fire’) as a draft standard for health IT developers looking to build applications that allow access to EHRs (electronic health records). This advance in technology opened the channel of communication between providers and patients and accelerated the exchange of data to whoever had permitted access. The application of this tool presents limitless opportunities in the world of health, from human care and public health data to veterinary health management.
By February 2017, FHIR evolved from draft standard to full standard in trial use. This maturity caught the attention of many within the healthcare industry. Although health IT professionals and developers represented the largest group attracted, FHIR drew interest from a multitude of healthcare stakeholders and demanded a response to how health information would be exchanged, retrieved, and processed. FHIR answered how the data would be transmitted and also allowed more efficiency for administrative and clinical tasks at a fraction of the cost. We are continuing to witness the utility FHIR provides and how the developing organization, HL7, advances the functional use.
Founded in 1987, HL7 is an international not-for-profit developing organization dedicated to providing a comprehensive framework for the integration and retrieval of electronic health information. Focused squarely on the delivery and evaluation of health information, HL7 is driving the FHIR model towards allowing everyone to securely access the right health data when and where they need it.
The current state of health information exchange finds itself anchored in documents like faxes, emails, and electronic transcripts. In order for providers or healthcare systems to understand a patient, they require the sum of their history in document format. While in theory this may sound effective and useful, in practice it fails to meet the standard of modern healthcare because it doesn’t allow the physician to understand context. Oftentimes, this leads to meaningful care limitations, inefficiencies in decision-making, and abbreviated data-analytics.
“If you just send me lab results or a list of allergies, that’s great…I need those things, but you haven’t told me the story of the patient, and that’s really important for a clinician to understand.”
– Micky Tripathi, CEO, Massachusetts eHealth Collaborative
Although the document supplied, like a PDF, might offer a surplus of critical information, it reads static. In order to successfully understand a patient’s history and background, it requires special effort to extract usable information from standardized documents. Enter FHIR. This developer tool presents the health information through what HL7 calls ‘resources.’ These resources act as forms within the developer platform and can act as information related to patients, administrative, or infrastructure components. Resources are fragments of highly focused data equipped with tags that uniquely identify each portion of information. Similar to a webpage address, or URL, each piece is coded specifically to pair with only that item of information. By entering a URL, your browser elicits a unique response to the task.
For example, when you visit your favorite webpage, like online.une.edu, and search for Health Informatics, your browser will populate a specific URL beginning with ‘https’ followed by a scattering of other characters. This is known as a query-retrieve system. Your browser generates a URL tied exclusively to that page and notifies the webpage server to respond to a task. Users across the globe have the ability to access that same page and complete the same search using any browser of choice, but because that URL pairs only to one page, the same results are seen. FHIR looks to provide the same function (streamlined applications similar to browsers that grant access to data regardless of the EHR operating system or user infrastructure) to health IT developers.
Advancing the Application of FHIR
Vendors and providers are eagerly trying to create new tools that leverage the capabilities of FHIR and learning how this interoperability solution can lessen some major challenges within healthcare organizations such as patient engagement, clinical decision support, and population health management. With backing from the Office of the National Coordinator, we continue to see the varied uses in equally varied scenarios. For example, IBM Watson Health has teamed with the Mayo Clinic and Epic Systems to create a clinical decision support model that offers access to data in real time for providers at the point of care. This allows them to enhance patient engagement and deliver more personalized and accurate care. The mission of these three groups to connect traditional sources of patient information with constantly changing healthcare information is made possible through FHIR.
FHIR will act as a crucial partner and source point on the road to interoperability. As major providers and healthcare organizations like HIMSS, Geisinger, and Epic look to advance the electronic health record model, we will see continued, growing application and use of FHIR. The use cases of FHIR rapidly evolve with the goal to democratize access, which will enable developers, regardless of healthcare experience, to build data sharing tools that reflect the best interest of the patient and the path future healthcare will take.
FHIR Technology Advances Electronic Health Records (EHRs)
One of the first widely-received applications of FHIR came with electronic health records, more commonly known as EHRs. Providing a software that supports and strengthens the use of EHRs will lead us to a more plug-and-play health landscape in which multiple providers and physicians will have access to the same health data, for the same patient, at the same time.
The future of FHIR will look very similar to the connected world we use today. For example, we use apps via mobile devices like tablets, cell phones, and laptops. We very rarely find ourselves sitting in front of the operating system interface like Apple or Android. Instead, we use that operating system as a vehicle to access third-party apps like Facebook or Twitter. Although Apple or Android did not craft or write those apps, it provides the platform for us to connect to them. FHIR will resemble a similar approach and execution. In comparing FHIR to the previous example, FHIR represents the operating system (Apple/Android), and the EHRs represent the apps (Facebook/Twitter).
“Eventually, we’re going to stop building the Swiss Army knife, and we’re just going to have a basic platform with lots of little applets sitting on top of it.”
– Stanley Crane, Chief Information Officer, Allscripts
FHIR in the Future
Healthcare continues to adopt the consumer-facing approach noticed across the world. As providers continue to increase the pace to find new ways of monitoring patient health and extract insights, FHIR enhances that process by providing focused access to data. This helps save time, bandwidth, and money for healthcare systems while simultaneously personalizing the patient experience. Plus, FHIR eliminates the issue of having multiple patient portals in an effort to contact providers or view records. To get a clear portrait of their health, patients will now have access to a holistic record to share with physicians and improve their personal care management.
FHIR also connects and reports the analytics acquired through wearable devices, glucose monitors, and fitness trackers to adapt more precisely to patient demands. The population of these device users grows every day and FHIR can serve as the missing link between the patient’s device and the patient’s health record. Joining these two worlds through FHIR provides physicians quick and easy ways to understand the meat of the data.
As patients lean more in favor of staying connected and more informed, FHIR will continue to support healthcare interoperability and provide a streamlined health management process in the world of the patient, the physicians, and the administrators.