- Fast Healthcare Interoperability Resources (FHIR) remains a draft standard and application programming interface, but that status doesn't mean this health IT resource is not ready for the big time, according to the head of Health Level Seven (HL7) International.
"There's this tension between making FHIR, which is not a normative standard identified in regulation and predicated for use, and a recognition that FHIR is evolving very, very quickly — sometimes nightly — and getting better with each iteration," HL7 CEO Charles Jaffe, MD, PhD, told HealthITInteroperability.com.
Recent rulemaking by the Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC) have both sought feedback from industry stakeholders on API use, particularly the role of FHIR.
But Jaffe contends that another force will determine the potential widespread use of the FHIR draft specification and API even in their "immature" state.
"ONC is entirely behind the use of FHIR, but the fact is that the marketplace will decide the utility of FHIR," he maintained. "We use the WIFI standard, which has always been a draft standard, so now we're up to 802.11ac. The industry is making modems and receivers to use that specification. It's not a normative standard, yet it works, yet it's hundreds of times faster than we had 2-3 years ago. Whether ANSI gives it its blessing or not, we have advances in technology which make it difference in how we communicate. And I believe FHIR will be the same way."
What's more, various components of FHIR are at different levels of maturity as its more than a simple API but an entire suite of resources with a multitude of applications.
"Although we have a lot of support from federal agencies like ONC and the work coming out of the CDC, VA, and NIH supporting the FHIR platform, the key is that FHIR isn't simply a standard," Jaffe continued. "It's an ecosystem. It's an entire platform which relies on the FHIR APIs, the FHIR resources which are at different levels of maturity, the OAuth 2.0 and OpenID for security and authorization, and a tremendous ecosystem of apps that are used inside and without an electronic health record."
Understanding the role of FHIR
To clinicians in general, health IT standards and specifications are less important than the features and functionalities they support.
According to Jaffe, the benefits for FHIR in a clinical setting is obvious when compared to how information sharing has historically occurred.
"If I fax them an EKG, we are both looking at the same document — there's no translation problem or ambiguity — but you can't reuse the data again. You have to put it back in a fax machine because it loses in effect its interoperability," he explained. "Now if you capture the EKG as a digital signal, which it was before it got put on a piece of paper, then you can use it and reuse it for whatever you want. That's interoperability."
FHIR likewise has much to offer providers, such as oncologists, who rely on an array of clinical registries to track the progress of their patients.
"A registry is fraught with errors in data entry and communication, and it's very expensive," said Jaffe. "As an oncologist, we have a cancer registry, a breast cancer registry, a receptor-positive breast cancer registry, on and on and on — each one with an added cost and added lack of true understanding."
Juxtaposed to clinical registries, FHIR enables the querying of health information in disparate systems à la Google.
"FHIR uses the exact same technology as does Google," Jaffe went on to say. "When you ask for the five best restaurants in Baltimore, there's not a database of restaurants in Baltimore. Google goes out and looks for that query on the web, albeit with a rather exotic algorithm to find those things, and assembles that information for you."
But FHIR goes beyond basic information sharing to aiding research on providers and patients, claimed Jaffe.
"From a research perspective, it allows you to look at medications and see if a patient's on a given medication has better blood sugars at the end of some specific timeframe than others — reducing the cost of research and the demand for better informed clinicians. The capabilities of FHIR transcend anything we've done in information sharing," he added.
But how does it work?
Given the healthcare industry's paranoia about health data privacy and security because of HIPAA, the concept of easily accessing health data in external systems could add to public unease. However, most consumers are familiar with the type of security FHIR leverages to maintain HIPAA compliance and the confidentiality of sensitive health information.
For Jaffe, using Amazon exemplifies how the health IT standard and API works in practice:
HL7 adopted standards that were created for the internet for security and authentication. When you log on to your Amazon account — there's a chance of course someone has stolen your identity — you have two-factor authentication and that authentication to Amazon says, "Yes, this is [blank]" and "he may conduct a transaction with us." The technology that HL7 uses is identical to that. We didn't reinvent; we use the ones that are used around the globe for authentication and security. If I'm going to another system and present credentials, the other system will allow me to query its data.
While FHIR may have a ways to go before shedding its "draft" status, its utility is already clear to health IT developers and healthcare professionals using the resource to advance interoperability in healthcare and with it the accessibility of health information.