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Friday / January 15.

What’s Next for FHIR?

If you had been in Las Vegas for HIMSS16 two weeks ago, you would have witnessed a promising moment for interoperability. During the opening keynote on Monday evening, HHS Secretary Sylvia Mathews Burwell announced a major commitment among healthcare industry players to improve the interoperability of electronic health records (EHRs).

According to Burwell, the vendors that provide 90 percent of the electronic health records used by hospitals nationwide have reached an agreement with the country’s top five largest private healthcare systems to collectively implement three “core commitments.” These commitments are intended to improve patient access to healthcare data, while enabling providers to fluidly share that data, and establishing a common set of standards for how health data is configured, organized, and utilized.

The promising new health data standard, FHIR, is in many ways the engine for this massive effort. HHS makes specific reference to FHIR in its press release, particularly with regards to the first of the core commitments, consumer access:

Many of the biggest health IT developers have committed to using standardized application programming interfaces and a single shared standard for communicating with one another, Health Level 7 – Fast Health Care Interoperability Resources (FHIR®), so that user-friendly resources, like smartphone and tablet apps, can quickly be made market-ready and compatible with one another. These advances will make it easier for consumers to access their test results, track progress in their care, and communicate with their providers.

Encouragingly, the large majority of health IT developers have already adopted FHIR. Major EHR vendors like Cerner, Epic, Allscripts, and athenahealth are currently building forward-looking platforms to accelerate FHIR’s development and implementation. And each week another batch of health IT vendors joins the HL7 community in the spirit of ensuring that FHIR becomes a widespread data standard.


The Rise of EHR Integration Platforms

The HHS announcement wasn’t the only promise of impending interoperability made at HIMSS16. With the rise in attention given to data sharing over the last couple of years, we have seen the emergence of EHR integration platforms, which appeal directly to the desires of healthcare providers and digital health developers by promising to make EHRs interoperable now.

These integration platforms act as what is known as “middleware,” a kind of software glue that connects EHRs to digital health technologies. The value proposition for these integration platforms typically involves ease of use, efficiency, and improved patient outcomes.

As was to be expected at HIMSS, plenty of startups were looking to stake a claim in this growing market. The pitch that startup X’s middleware platform “does what FHIR promises to do and does it now” buzzed around the convention halls. What these vendors were basically saying was “true interoperability is possible today, and our platform is the missing key.”


Two Distinctions

Middleware platforms will have their place in the health IT ecosystem for years to come. But an important distinction needs to be made between the two types of middleware platforms that are currently promising to improve the interoperability of EHRs. 

One type of middleware platform will help in the adoption and implementation of a wide-reaching data standard (i.e. FHIR), while the other will do the opposite because its business model is threatened by that standard. (Often, this second type of platform will feel threatened by FHIR simply because its services are in higher demand when data standards are unreliable.)

Another important distinction is that FHIR is ultimately just a data standard, a documented agreement on representation, format, and definition for health data. When claims are made that a certain integration platform already does everything that FHIR promises to do, the point of FHIR is being missed entirely.

The purpose of FHIR is to benefit the entire healthcare ecosystem by making data easier to work with among disparate systems, thus driving down costs and reducing systematic inefficiencies. This in turn will greatly benefit patients, providers, health IT professionals, administrators, and so on.

So it’s important to be cautious when considering proprietary technology solutions that promise to be a “a magic bullet.”


The Hope for Interoperability

The undeniable truth is that interoperability is one of the largest issues facing the healthcare system today. We will continue to see ventures looking to strike it rich by providing integration solutions in the near-term. That aside, HHS Secretary Sylvia Mathews Burwell’s HIMSS announcement reveals the healthcare system’s great hope for the fast approaching future of widely accepted standards, ease of data transfer, and patient empowerment.

The Office of the National Coordinator for Health Information Technology’s 2016 Interoperability Standards Advisory best conveys the hope for FHIR. Although calls for interoperability ring loudly in Congress, the immediate future of interoperability will come about in more targeted, private instances. These are the bubbles in the simmering pot of healthcare, and FHIR is the heat source. The hope is to get the pot to boil.

If your organization falls into the category of health IT developer, healthcare system, or a provider, technology, or consumer organization, consider joining the movement and signing the Interoperability Pledge.


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