Is FHIR our Only Fast Track to Interoperability?

By Corey Spears, an exhibitor at the HIMSS Interoperability Showcase™ at the 2018 HIMSS Global Conference & Exhibition, and Director of Healthcare Interoperability Standards for Infor Health

Everyone in health IT is talking about the HL7® FHIR® standard. And they should.

The standard presents one of the greatest opportunities to achieve true interoperability. That’s why the best and brightest minds in the industry continue to come together to explore its possibilities and promise.

The value of interoperability is clear: 80 percent of healthcare providers said that electronic data exchanges increased their efficiency, while 89 percent of healthcare providers said such connectivity improved their patient’s quality of care. And that’s what it’s all about.

Proceed with Caution

However, while we tout the power and possibility of FHIR, we should also proceed carefully and methodically. As quickly as we are moving, we must remember to take the time to ask ourselves some important questions.

  • Do we automatically accept the FHIR standard as the one and only path to our interoperability goals?
  • How do all of our other, significant, technology investments fit into our plans?
  • Do we just leave those behind (or, as I call it, “rip and replace”)?

These are crucial questions during an increasingly complex time in healthcare IT. As we continue to figure out which standard is fit for purpose, we have outside technologies – mobile devices and apps – coming at us and affecting our operations and technology plans. The good news is that with the right planning and the right technology choices, we can leverage all of these, together, to bridge any gaps that may occur.

The last thing we want and need in healthcare is any kind of digital divide among organizations and systems, so it’s best to proceed smartly, while not forgetting our legacy install, and move forward with an expected transition time.

Evaluate All Paths

I want to offer a few ways we – as health IT leaders, innovators and doers, can determine how to best evaluate all the paths to full connectivity – before the investment and implementation.

  • Start at the end. Be sure to get a clear understanding of your ultimate goal. That means assembling cross-functional stakeholders and taking a team approach to priorities and goals.
  • Look for guidance. There are plenty of resources out there to draw from. For example, every year, the U.S. Office of the National Coordinator for Health Information Technology (ONC) n releases an Interoperability Standards Advisory that provides guidance and a rating scale for numerous standards based on applicability, maturity, adoption level and other metrics for various use cases.
  • Ask the right questions. These include:
    • What is your current investment in HL7 v2 messaging and what are possible costs and benefits of replacing or changing your system?
    • Are your system capabilities in place?
    • What is the standard’s ease of implementation?
    • Has the standard successfully been used for this purpose?
  • Does it scale? We are in the era of big – and getting bigger – data. Any system should scale to meet those increasing needs, many of which we can’t predict at this point in time.

If we are to truly implement a system that supports the Triple Aim, we need to keep in mind these questions, and commit to making informed choices by looking at the benefits and drawbacks of all standards.

For example, HL7 messaging is mature and useful for large volume data transactions, yet is largely limited to push transactions. When we look at C-CDA, we see benefits, such as being able to handle a number of use cases and to see information in a snapshot of time. A drawback, however, is the risk of latency in the face of information size and complexity, among other issues.

Ultimately, no matter how many of us get together and promote the standard, it will be its usability and ability to prove value where it’s most needed – patient care and outcomes – that will determine its depth and breadth of adoption.

Even the HL7 CEO Charles Jaffe, MD, PhD, confirmed that, "ONC is entirely behind the use of FHIR, but the fact is that the marketplace will decide the utility of FHIR."

Experience up-and-coming digital health innovations at the HIMSS Interoperability Showcase™.

FHIR® is the registered trademark of HL7 and is used with the permission of HL7.