- Earlier this month, members of the Regenstrief Institute demonstrated the potential for Fast Healthcare Interoperability Resources (FHIR) to aggregate and merge patient health data from separate data sources.
While widespread FHIR use remains a ways off, its maturation into a useable health IT standards and application programming interface (API) should assist providers in responding to increasing patient demands for health data access.
"The shift toward more patient access to their record and the provider community being more comfortable with that — it's simply a matter of a generation," Regenstrief Institute investigator and Clem McDonald Professor of Biomedical Informatics at Indiana University School of Medicine Titus Schleyer, MD, PhD, told HealthITInteorperability.com.
"When you think of millennials who don't know anything but having access to all their data everywhere," he continued. "When they start flooding the healthcare system and the more established physicians get washed out, it is going to reach a different equilibrium than what we have now."
The recent Regenstrief FHIR demonstration showed that the health IT standard and API when deployed in a provider EHR and health information network in a closed environment (i.e., sandbox) can enable an end-user to compile a patient's record from disparate data sources. In the next phase of the project, the Regenstrief Center for Biomedical Informatics will pilot-test the FHIR-enabled technology more widely and likely include strategies for dealing with different data vocabularies, patient matching challenges, and variations in FHIR implementation.
The health IT standard and API FHIR has the potential to change how patients access and use their health data. However, its limited use means that providers must still rely on a limited number of options for enabling patient access to health information.
If the use of FHIR to aggregate and merge patient data is still a work in progress, how are current providers responding to patient requests for improved access to health information?
These secure web-based applications are the simplest way for providers to enable patients to view parts of the health records and in many instances send messages to providers, request prescription refills, and schedule appointments, to name a few.
Patient portals generally rely on the hypertext transfer protocol (HTTP) and hypertext markup language (HTML) — web standards for accessing data stored on provider servers, on premise or remote. Authentication is required of patients and in some cases takes the form of two-factor authentication for consumers to prove their identity to the host.
Patient portals are quick and easy solutions to patient access to health data; however, patients seeing multiple providers at different locations often lack the means to consolidate their records into a single place.
Additionally, providers control the types of data made available to patients via the patient portal or prevent patients from making corrections to erroneous data.
The Blue Button Initiative dates back to 2010 when it was first championed by the Departments of Defense and Veterans Affairs to give consumers electronic access to health data from doctors, hospitals, or other providers using a simple tool.
Now under the purview of the Office of the National Coordinator for Health Information Technology (ONC), the Blue Button toolkit goes beyond view and download to include transmit. Indeed, the tool supports view using TXT and HTML and downloading using PDF and XML. But it also includes multiple means for transmitting data.
Second, the Direct Project developed the Direct standard, a secure/multipurpose internet mail extensions (S/MIME) standard which relies on public key encrypting and signing of MIME. Only trusted recipient with Direct addresses can receive this information over the web.
Third is the web-service SOAP which standards for simple object access protocol that allows information to be sent in XML format.
Lastly, secure attachments of encrypted files allows information to be sent privately over email.
All the aforementioned transmission protocols and standards leverage the consolidated clinical document architecture (C-CCD) designed by HL7 and espoused by ONC's health IT certification to specify how clinical data is stored.
Emerging health IT standards and APIs
With its final rule for modifying Stage 2 Meaningful Use and establishing requirements for Stage 3 Meaningful Use, the Centers for Medicare & Medicaid Services (CMS) called for the use of APIs.
Specifically, the federal agency supported the use of APIs to enable patients to view, download, or transmit their health information and patient-specific resources "using any application of their choice that is configured to meet the technical specifications of the API in the provider's CEHRT."
In not specifying a single API, CMS has left open the possibility for any number of health IT standards and APIs to assist providers in meeting requirements for electronic patient access to health information. FHIR would appear an obvious one with three programs already promoting its development into a dynamic standard and API.