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What FHIR Has Learned from Past Interoperability Failures

By Kyle Murphy, PhD

- The Office of the National Coordinator for Health Information Technology (ONC) and its initial draft of the nationwide interoperability roadmap are receiving the lion's share of attention at the moment as the healthcare industry considers the right pathway forward for achieving a learning health system.

But too much of a focus on the future could lead to  failure in the near term, especially if the shortcomings of previous interoperability endeavors are not learned from. That is the belief of the leader of Health Level Seven International (HL7) who understands the difficult position the ONC finds itself in currently.

"The roadmap was created in such a fashion that allows it to be relatively flexible," HL7 CEO Charles Jaffe, MD, PhD, tells HealthITInteroperability.com. "Of course, there are people who will want the ideas to be as specific so that there is not optionality. There are others who will like a different approach in which the goals are clearly defined and the pathway there has opportunities that are based upon the growing body of technology. The latter is more appropriate."

So why is HL7 so interested in the challenge before the ONC in balancing being prescriptive and flexible? The standards developing organization is attempting to achieve the same end in its work on Fast Healthcare Interoperability Resources (FHIR) and what it can learn from its experience with Clinical Document Architecture (CDA) and the Consolidated CDA (C-CDA).

"The first round of consolidated CDA was such an example," Jaffe explains. "We rushed to a very prescriptive and detailed their own devices, the industry had to do what it could to manage to still define constraint."

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The result of that approach has led to more work by HL7 on the standards, but the organization is looking to gain experience from the process. "Not only have we advanced in the next release of the consolidated CDA, but we also enhanced CDA itself. The success of that approach will be a good barometer for the likelihood that we can achieve that when we move forward," says Jaffe.

According to the HL7 CEO, the growing pains of CDA and C-CDA will be FHIR's gains:

We certainly can make it easier by reducing the optionality. Then we're stuck with the never-ending complaint that conformance reduces innovation. With FHIR, we can make it sufficiently flexible and yet demand a degree of conformance so that one can assemble resources and put them in any envelope or any rendering tool and still retain the interoperability. That's the objective and why the approach to FHIR is fundamentally different from other specifications.

Building on FHIR

The utility of FHIR is straightforward: Two systems can represent the same biologic concept in a different ways but still successfully exchange data. For Jaffe, it is similar to two individuals having a conversation.

"You and I can have a detailed conversation in which I make numerous grammatical errors and your brain will more than likely sift through them and either interpret it correctly or not even hear it. A computer is not nearly so forgiving as you are," he maintains.

Beyond the straight exchange of clinical health data, FHIR could also provide a simpler and more direct mechanism for finding information in other EHR and health IT systems.

"There are other clear features of FHIR, such as the ability to do seamless queries," Jaffe explains. "At some point, I can imagine that each entity can keep their own data and with appropriate authorization and security access that data without a need for a registry. That would be novel."

FHIR still has a ways to go toward realizing its potential. The next draft standard will open balloting next month and undergo future iterations and testing before becoming a normative standard. The good news is that more than one hundred private organization are moving forward to implement FHIR from which HL7 will receive valuable feedback.

That being said, the organization is looking to demonstrate some of FHIR's capabilities during HIMSS15, which takes place next week in Chicago. Much of this is made possible by the work of the Argonaut Project that was able to get the cooperation of major vendors to commit to working on FHRI.

"At HIMSS, we're going to see vendors who have developed gateways, exposed their data if you will, using FHIR Release 1.1," says Jaffe. "The functionality of FHIR will be demonstrated clearly by the numerous booths."

While many will line up in Chicago to see FHIR in action, some of whom may not be in healthcare specifically.

"The pharmaceutical industry has realized that FHIR is a rather remarkable way for them to access clinical data rather than the elaborate workarounds that they have used or the reliance on claims data," Jaffe reveals. "They have come to realize that the quality of the clinical information not only informs their clinical trials but also adverse event reporting and other processes that have been left by the wayside when it comes to other solutions."

Although FHIR has a long way to go, its prospects appear bright.

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