Friday, April 10, 2015

FHIR (Fast Health Interoperability Resources) Is Really Starting To Be Taken Seriously Globally.

This appeared a little while ago:

FHIR Lights the Way to Interoperability

by Har Puri Thursday, March 19, 2015
Ever since the move from paper-based to electronic health records, people and organizations have been working to advance health care interoperability -- the ability to exchange information between EHRs. The vision has been to interconnect EHRs and give providers the ability to look up a patient's treatment history nationwide or even punch a few buttons on the computer to send supporting documentation for a referral to another provider. The idea is that the receiving provider, likewise equipped with an EHR, would simply import the information and browse the patient's longitudinal medical record in support of the final diagnosis.
The dashboard shows that public policy initiatives, such as the CMS EHR incentive programs, have driven hospital-based EHR use into the 90 percentile range. In 2013, more than nine in ten (93%) hospitals possessed certified EHR technology. But, we have not made much progress to the utopia of unhindered information exchange, such as in the case of referrals mentioned above. Half of the hospitals cannot query patient health information from external sources, and more than half cannot get or send secure messages from their EHRs. In 2013, only 14% of physicians surveyed could electronically exchange information outside their organization.
Why does patient information exchange continue to elude us? Key findings from the eHealth Initiative's 2014 Survey on Health Data Exchange singled out cost and technical challenges as the biggest inhibitors of interoperability. The survey further identified three major needs:
  1. Standardized pricing and integration solutions from vendors;
  2. Technology platforms capable of "plug and play"; and
  3. Federally mandated standards.
The large number of EHR systems, each with unique interface requirements, makes custom coding necessary when interfacing with proprietary methods or health information exchanges, which use interface standards from Integrating the Health Enterprise. Since this custom coding is a labor-intensive undertaking, we have to look elsewhere in order to reduce interface costs. Later attempts to make things simpler by using point-to-point secure email (The Direct project) and the Consolidated Clinical Document Architecture (C-CDA) have had partial success due to the one-way communication design and the inability of many EHR systems to successfully parse the XML information into the EHR.
With intent to create a federally mandated standard which enables plug and play, attention is now focused on the last two needs in the eHI survey. In fact, the federal government tasked JASON, an independent group of scientists who advise the government on matters of science and technology, with recommending ways to improve interoperability. Their report, titled, "A Robust Health Data Infrastructure," was released in April 2014. ONC further commissioned a JASON report task force to study ways to improve health information interoperability. The task force recommended:
  1. Using a public (well known, open source, standards based) application programming interface (API) to interconnect systems through both push and pull; and
  2. Finding an intermediate level of data exchanged by the API that is not as ambiguous as HL7 version 2 and not as bulky as C-CDA but can still perform both document style and discrete data exchange.
Fortuitously, the experts over at Health Level Seven International were already working on a new way to interconnect systems, applying lessons learned from the practical implementation of HL7 version 2, which was published about 25 years ago, and version 3, which was published 10 years ago. This new standard -- called Fast Healthcare Interoperability Resources, or FHIR -- was modeled after the new Web-based technologies that worked well on a large scale for Google, LinkedIn, Facebook, Twitter, etc. Having reached a milestone called Draft Standard for Trial Use (DSTU), FHIR is in an incubation state where standards are rigorously tested. However, some proponents such as Cerner, Epic, Intermountain Health System and Boston Children's Hospital have already built Web applications using it. This enthusiasm for adoption attests to the attractiveness of FHIR.
Because FHIR looks very promising, the Office of the National Coordinator for Health IT added this emerging standard to its 10-year interoperability vision in January. FHIR must, however, attain the status of a fully developed published standard before it can be mandated. To accelerate the development of FHIR to the next milestone DSTU R2, Health Level Seven International launched an initiative, called the Joint Argonaut Project, comprised of almost a dozen health systems and vendors including Epic and Cerner. In order to understand what more needs to be done to achieve standardization, let us examine FHIR in more detail.
More here:
In the same week we also had this:

Halamka finds the art in standards making

Posted on Mar 20, 2015
By John Halamka, CareGroup Health System, Life as a Healthcare CIO
The March 2015 HIT Standards Committee was one of the most impactful meetings we have ever had. No, it was not the release of Meaningful Use Stage 3 or the certification rule. It was the creation of a framework that will guide all of our work for the next several years - everything we need for a re-charted standards harmonization convening body as well as a detailed interoperability roadmap, complementing the 10 year general plan developed by ONC. Thanks to Arien Malec for yeoman’s work in both areas.
We started the day with an overview of current security risk presented by Ron Ross, National Institute of Standards and Technology (NIST). Admittedly I missed that presentation. Although my flight from Dubai to Washington was early, Metro was shutdown due to an equipment failure at the Rosslyn station.     I’m told it was a sobering overview of the increased threats we all are facing.
Next we heard the most important presentation thus far in 2015, Arien Malec and David McCallie presenting the work of the Architecture, Services, and APIs workgroup. The key recommendation was aligning healthcare standards with the approach that has been used by the groups creating internet standards - bring running code and embrace phased improvement in real world implementations. They elegantly categorized the work to be done on existing standards while transitioning to a broad implementation of future standards - FHIR, OAuth2, and REST. The entire Standards Committee applauded the effort which contains enough detail to implement now. It provides all the interoperability planning detail that Congress has been asking for. We declared the effort, a yellow brick road leading to standards nirvana, with courage, wisdom and heart (ending with finished FHIR specifications from the land of Oz)
More here:
Here is a link to some details from Wikipedia.
We in Australia need to keep a close eye on what is happening with FHIR - especially since there is some national interest involved - see bold paragraph just above.


Anonymous said...

And the fastest why to put a FHIR out in Australia is to give in NEHTA's Head of Architecture. Job done

Terry Hannan said...

Following conversations with Grahame Grieve on these FHIR and NEHTA/Feds matters last week I think he should be acknowledge and SUPPORTED by the Feds. Evolutionary leaps in HIT are uncommon and need to be supported.