and all the HIEs can communicate with one another,” he added.
Experts say one thing that would help the industry get to that point faster is a more modern standard for data exchange, which has been in development for years and health systems are just now starting to use. Another idea is a nationwide patient identifier, which could help reduce costs and documentation errors. Let’s examine both concepts.
Heating Up
Fast Healthcare Interoperability Resources (FHIR) is a much-anticipated standard for exchanging health data electronically. It’s the latest in a line of standards developed by Health Level Seven International (HL7), a nonprofit based in Ann Arbor, MI. According to its website, HL7 is used at more than 1,600 healthcare organizations that span more than 50 countries.
Grahame Grieve, an interoperability consultant who is co-leading the FHIR project, says one reason it has many leaders in healthtech excited is that FHIR would bring health data exchange into the latest era of computing. Whereas previous HL7 standards were developed using a document-centric approach, he says, FHIR is built around “resources,” meaning individual sets of information like lab results or medication lists. Clinicians can pinpoint the data they need faster with this change, part of a broader shift to a modern, Web-based framework that uses application programming interfaces (APIs) to send and receive data.
There is buzz surrounding FHIR not only because new technologies are being used, but because they’re being incorporated in an intuitive manner that leverages the prior work done on HL7 standards, Grieve says.
“The content is deeply aligned with what [users have] done in the past,” he says. “That makes it an easier transition. A big part of why people like FHIR is it takes the knowledge of having done this stuff for 40 years and adds it to the [latest] technology. That combination is proving very attractive to implementers.”
Indeed, Grieve says EHR vendors have partnered with some of their most prestigious customers—Cleveland Clinic, Duke University Hospital, and Mayo Clinic among them—to set up FHIR-based connections. Some of them are already live, he says.
But many health systems will have to continue waiting. Arien Malec, vice president of data platform and acquisition tools at RelayHealth, a subsidiary of McKesson (NYSE: [[ticker:MCK]]), said in an interview that he expects U.S. hospitals and clinics to upgrade their technology to support FHIR-based APIs in the next two to three years. Grieve says next year, his group will release a “working” standard that’s not fully fleshed out but will have “some well-recognized, solid parts.”
“That’s what the big EHRs and the government will be targeting,” he says.
But the new data-sharing tools won’t fix all the problems.
When a new HL7 standard becomes available, health systems don’t often go back and upgrade previously installed connections, says Dan Wilson, founder and CEO at Moxe Health, a Madison-based startup focused on EHR integration.
“FHIR isn’t going to replace the need to continue leveraging [existing] HL7 interfaces,” Wilson says. “Vendors aren’t going to go back and retrofit a bunch of interfaces that already exist, and health systems aren’t going to rip out and replace interfaces that are already in place.”
Plus, said Robke, the Cerner executive, getting all the technical pieces into place is only one step in the effort to improve the ability to share patient records. Parties must agree on terms—like whether patients must opt-in for their records to be shared, and who will pay to set up the connections—and ensure they don’t violate patient privacy rules or any other law.
“The emergence of FHIR will hopefully make things simpler,” Robke said at last month’s panel. “But [it’s] just a standard. You still need contracts and governance.”
Still, healthcare providers and EHR vendors believe FHIR holds more promise for
