Is FHIR the answer to healthcare interoperability problem? A look at the new protocols potential and why it could enhance pop health efforts, with insights from Wellcentive’s Phillip Burgher.
Health information technology’s (HIT’s) potential may be expanding, but so is the size of its greatest challenge and elephant in the room—interoperability. The industry is riding a wave of evolution fueled by digital connection, yet there has never been a greater disconnect when it comes to utilizing digital data effectively in healthcare, both literally and figuratively. However, it looks like that’s all could change thanks to an emerging protocol.
FHIR (pronounced “fire”) stands for Fast Healthcare Interoperability Resources. It’s a specification of HL7 that outlines how to support an API for the purpose of exchanging data among HIT systems. The promise of FHIR is that it will make the finer and more granular data elements more efficiently accessible and transferable via API interfaces. Instead of having to exchange whole documents or larger data sets, FHIR utilizes the concept of “Resources” to outline very basic sets of structured data. A resource, for example, could be defined as a medication list or lab results.
FHIR has the potential to dramatically change how the healthcare industry exchanges data, especially when we talk about true data integration with Electronic Medical Records (EMRs). Furthermore, it will drive app innovations, as startups devise ways of fully utilizing data to improve healthcare workflows, decision-making, and patient engagement. While standard APIs like Apple’s HealthKit have done a good job at getting fitness and survey data into an EMR/EHR, there have been few inroads into getting clinical data out. True data interoperability means accessing crucial clinical data with greater specificity, and most importantly, in real time.
There may be no area more open to benefitting from FHIR’s potential than population health management (PHM). Many of PHM’s challenges stem from accessing actionable data in a timely fashion to prevent and/or manage the chronic conditions of those who need it most. PHM solutions offer robust tools for measuring, monitoring and supporting the decision-making necessary to execute the proper services. However, what remains challenging is integrating that data with the larger enterprise data created from a system’s EMR/EHR. As Wellcentive’s Director of Software Development Phillip Burgher points out in his blog on the subject, providers still largely rely predominately on EMRs/EHRs as their primary point of data entry.
EMRs are the popular data-entry choice, but they lack the functionality to support population health management practices. You need both solutions, and for optimal success, you need them to work together. Perhaps FHIR can produce a happier marriage between the two, as detailed in one such use case Burgher proposes regarding patient alerts:
“Because accurate alerts require a complete and precise longitudinal chart, EMRs simply do not have the data to offer that functionality,” he said. “Tools used for population health management should inherently offer such a complete longitudinal chart. The difficulty in this instance for providers is one of workflow specifically, having to use two separate tools. Furthermore, having to leave the EMR, log in to a separate application, search for a patient again, and adjust one’s mindset to a completely new screen layout is difficult, and makes an already cumbersome EMR process even more onerous.”
He continued: “Fortunately, the FHIR specification provides for an Alert API. This means that rather than leaving their EMR, providers can have their EMR call the Alert API of their population health management tool, get the alert data on the fly, and have the EMR render it in real time in the patient’s chart.”
Additionally, such digital connection could aid to remedy the disconnect between care managers who update care plans via PHM tools and providers who continue to primarily utilize EMRs. FHIR allows for a care plan API that could be leveraged to bridge a potential gap in tools, by allowing the PHM tool to push updated care plans to the EMR for providers to use, according to Burgher.
This could literally creative a cohesive and comprehensive view of patient’s medical data. Burgher says Wellcentive plans to support those two scenarios, as well as many others to improve patient outcomes and reduce costs and improve workflows. While FHIR’s promise of true interoperability seems still to be a bit “Pie in the Sky,” Burgher points to very two real slices of improvement made possible via FHIR— and he’s not the only one who see such potential.
National coordinator Karen DeSalvo kicked of HIMSS16 last month by announcing three new developer challenges (totaling $625,000) focused on advancing interoperability through FHIR. The challenges are delineated into three specific categories: a consumer-facing, vendor-neutral app based on FHIR; a provider-facing app; and essentially an app store to house FHIR-based apps for download.
The “challenges” are an opportunity for the government to engage entrepreneurs in building technologies that make more effective use of health data for patient-centric care. “It’s time for us to see some digital dividends,” DeSalvo said, “to really make that data sing.”
It appears likely that we will be hearing of FHIR’s potential for population health and other delivery services for some time. Will it completely solve the puzzle that is interoperability in healthcare? That’s the question we will keep asking—right along with the developers who will finally be engaging with the industry’s elephant in the room.
