This is the second blog post in a 3-part series on advancing interoperability. See the first blog post, Interoperability—Yesterday, Today, and Tomorrow, and the third blog post, Supporting Interoperability During A Pandemic.
In our digital lives, we have become accustomed to apps and services operating almost seamlessly. If I miss a turn while following the step-by-step directions from my favorite navigation app, the system auto-corrects and presents a new route. Web apps like this are now so commonplace, most of us don't give much thought about how they work.
As providers, patients, and caregivers, we often wish our health information technology (IT) systems and apps worked that seamlessly. Far too often, the gaps in our fragmented care processes leave patients in the lurch.
Behind the scenes, while I’m following (or not following, as the case may be) those directions, my phone is performing its magic by leveraging a constellation of standards. For example, it uses GPS for getting geolocation information and HTTPS—along with a whole suite of Internet standards—for communicating securely with the remote server that computes possible routes from its vast cloud-based map platform. The application software itself (which may be developed by a third party) interacts with my phone's operating system, and the services on that remote cloud platform use application programming interfaces (APIs) that specify the format of requests and provide the responses back.
A passionate band of technology-minded health innovators are bringing that seamless connectivity of the web to health IT systems and applications. FHIR—which stands for Fast Healthcare Interoperability Resources—is a formal health data standard specification developed and published by HL7. FHIR applies the philosophy of the web to healthcare and provides a public domain, vendor-neutral API standard for health data that is transforming the health landscape. Rather than everyone doing it their own unique way, FHIR specifies a common approach to exchanging health data.
Since its first draft back in 2011, FHIR has seen widespread adoption throughout the health ecosystem. Current estimates show that approximately 96% of hospitals and 74% of clinicians in the U.S. have electronic health record systems (EHRs) with FHIR API capabilities. The Office of the National Coordinator for Health IT has issued a proposed rule that requires using FHIR as the API standard for enabling seamless and secure access, exchange, and use of electronic health information. Big tech companies including Amazon, Google, IBM, Microsoft, Oracle, and Salesforce have already publicly committed to using FHIR in their solutions for improving healthcare interoperability. Apple has embraced FHIR as the standard for bringing health data from various provider EHRs to your iPhone. And earlier this year, the National Institutes of Health issued a notice encouraging researchers to explore FHIR’s capabilities to use clinical data for research purposes and to enhance research data sharing.
With this level of market penetration, FHIR is clearly a technical success. But, as FHIR founder and visionary Grahame Grieve is quick to point out, its primary contribution isn't the technical standard. FHIR's real value is the community that has come together around it. The community is a large, diverse, and open group of people working together in a coordinated process to agree on how to exchange health data. Together, the community is producing a freely available, global public good whose value is shared among everyone and increases as more people contribute to and use it. I shared this perspective in my former role leading the development of the Logical Observation Identifiers Names and Codes (LOINC) terminology standard where we expressed our community values in the Manifesto for Open Terminology Development.
"FHIR's real value is the community that has come together around it...Together, the community is producing a freely available, global public good whose value is shared among everyone and increases as more people contribute to and use it."
The output of the FHIR community's work is a formal technical standard that provides a common data model for health information and the rules for how any system can exchange that data. FHIR serves as a common framework, or data model, that organizes health information into extensible building blocks called "resources." FHIR specifies resources for different information types, including administrative details such as practitioner, patient, organization, and device, as well as many types of clinical information such as conditions, medications, diagnostics, care plans, and more. When these resources are populated with actual patient data, they can use codes from standard terminologies (such as ICD codes for diagnoses, LOINC for observations, and RxNorm for medications) so that their meaning is understood across systems. FHIR also provides a means of exchanging resources with different technical approaches—including via an API—by exchanging documents, sending and receiving messages, or by invoking services. Regardless of which mechanism is used for exchange, the format of the underlying information is the same.
For RTI and its clients, FHIR (both the community and the standard) helps address many longstanding challenges related to health data interoperability. Whether exchanging structured and coded health data between systems or devices, providing real-time access to data for mobile apps, or using automated techniques to identify people eligible for clinical trials, FHIR offers a scalable approach to "defragmenting" health data.
As FHIR's disruptive innovations are transforming the health IT landscape, we anticipate cascading effects as the community expands its focus. For example, the Da Vinci project is using FHIR to help payers and providers improve clinical, quality, cost, and care management outcomes. There are also emerging efforts to represent clinical knowledge artifacts, such as clinical protocols, decision support rules, quality measures, clinical evidence summaries, and guidelines in computable, shareable forms. RTI continues to bring stakeholders together and transform care coordination using FHIR in efforts like the Post-Acute Care Interoperability (PACIO) Project and the Patient-Centered Clinical Decision Support Learning Network.
If you’d like to learn more about how to easily share and interpret health data with data standards like FHIR, RTI is ready to help. See our health IT capabilities and contact us for more information.
Disclaimer: This piece was written by Daniel Vreeman (Senior Clinical Data Standards Lead) to share perspectives on a topic of interest. Expression of opinions within are those of the author or authors.