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How Does FHIR Fit into Recent Interoperability Initiatives?

Over the past few months, APIs have been the talk of the healthcare industry, pushing HL7's FHIR into the spotlight for interoperability.

By Sara Heath

- Plenty of talk supports the position that application programming interfaces (APIs) will enhance health data interoperability, particularly a leading API standard known as FHIR.


Health Level 7’s Fast Healthcare Interoperability Resource (FHIR) is a data standard that helps different health applications work on the different interfaces that exist in the industry (such as an Epic Systems or a Cerner interface).

Much like how webpages work despite whether you use Google Chrome or Internet Explorer, or the Twitter app works on both iPhones and Android phones, FHIR apps aim to work across all platforms.

Because FHIR is arguably one of the most well-known efforts out there toward promoting API development, it is important to keep tabs on the moves it is making in the healthcare space, as well as how it relates to recent industry changes. Below, HealthITInteroperability.com breaks down of some of the most recent new surrounding FHIR:

FHIR supports ONC interoperability app challenges

READ MORE: 4 Initiatives Advancing Healthcare Interoperability in 2017

READ MORE: Health Data Integrity the Focus of ONC Innovation Challenge

READ MORE: Colorado HIE Using FHIR APIs for Patient Health Data Viewing

At the 2016 HIMSS conference, ONC announced two interoperability app challenges aimed at promoting the FHIR app economy.

With prizes totaling $625,000, the competition tasked participants with creating patient-facing and provider-facing apps. The competition also included a contest for an app discovery site which would act as a marketplace for interoperable apps.

According to ONC’s Karen DeSalvo, these competitions aimed at promoting app interoperability to help providers and patients seamlessly exchange health data across different interfaces.

“This strategy will help us reach the consumer and provider-friendly future of health IT we all seek,” said DeSalvo. “It reflects our guiding principles that consumers and providers should have easy, secure access to health information and the ability to direct that information when and where it is needed most.”

HL7 responds to ONC’s Interoperability Standards Advisory

In response to request from ONC, HL7 International, FHIR’s overarching governing body, wrote to the agency adding its input to the 2017 Interoperability Standards Advisory.

Overall, HL7 noted ONC should add more information regarding mobile technology, emerging interoperability standards, and interoperability standards maturation.

With regard to mobile technology, HL7 said that most standards detailed in the Advisory were not entirely applicable to mobile, but are rather better suited for EHR use. Specifically, these standards can help facilitate data exchange between physician-facing technologies and patient-facing technologies, such as smart phones or wearable technologies.

“There is a need for standardization of communications between consumer healthcare devices, smartphone/tablet apps, PHRs, and EHRs,” HL7’s CEO Charles Jaffe, MD, PhD, and board chairperson Patricia Van Dyke, wrote in a letter.

“Overall, we suggest focus on a new category of interoperability needs and standards. Some of the needs may be met with emerging standards (e.g., FHIR), while others are needs that currently have a gap in standards.”

The pair also explained that the advisory should include more information on emerging interoperability standards. Jaffe and Van Dyke do not specifically mention FHIR in this passage, but such a standard is one that could be referenced in this comment.

“Given that one of the primary purposes of the Advisory is to identify best-of breed, promising standards that are in earlier stages of development and with significant potential to be finalized, adopted and widely used, HL7 recommends that ONC consider expanding the identification of such promising standards, and not concentrating on the list of standards that fully mature, in production and widely implemented,” the pair explained.

APIs gain support in proposed MACRA implementation

Also in April, CMS released its long-awaited proposed MACRA implementation, putting heavy emphasis on population health management by way of robust interoperability via APIs.

Although CMS did not directly mention the use of FHIR in its proposal, the plan is important because it so clearly advocates for better API development, which inevitably involves FHIR.

Provisions within MACRA, including the Merit-based Incentive Payment System (MIPS), takes advantage of the 2015 Certified EHR Technology Criteria, which itself calls for providers to use APIs. API developers will need to use such information to help inform their work to best fit the needs of patients and providers.

“Because this proposal is aligned with the 2015 CEHRT, physicians will be using technology with open APIs to allow analytics tools and devices easier connectivity,” said CMS’s Andy Slavitt in a press call upon release of the proposal.  “We urge developers and the technology community to take advantage of the proposed flexible regulations when they’re ultimately finalized so they can design around the everyday needs of users, rather than designing around the one-size-fits-all regulated approach.”

As noted above, CMS made no specific mention of FHIR in its proposals; however, given the fact that FHIR is a leading API standard, such news inevitably affected how app developers will create their tools in the future.



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