Is your healthcare facility on FHIR? It should be!

Traditionally, healthcare IT changes incrementally. Over time, more and more companies build more and more products that are increasingly complex. With each new release, every product gets bigger and better, based on the vendor’s roadmap. These releases tend to collect more data and embed these data into increasingly complex systems. On the surface, these changes look like amazing progress. But when we dig a little deeper, we see that these incremental changes make the interoperability problem worse. Unfortunately, after decades of incremental IT “progress”, the healthcare system needs a radical leap forward in interoperability.

With the invention of the Fast Healthcare Interoperability Resources (FHIR) standards, we can see a future where interoperability no longer hinders rapid innovation and major progress. On its surface, the ability to make innovative changes in healthcare may seem minor when viewed individually. But the ability to build a common library of apps that can effortlessly exchange data between systems is a quantum leap forward. When FHIR becomes the industry standard—which is happening quickly—it could potentially save millions of dollars and thousands of lives.

While the implications of the new FHIR standards and interfaces are immense, its innovative nature stems from three main key factors. First, FHIR can unlock the healthcare data in place. Second, FHIR can expand the pool of available developers. And third, FHIR can empower facilities in deciding the major directions and capabilities of their healthcare IT systems. Keep reading to discover more about these factors that make FHIR so important to healthcare facilities. If you’re unsure about the basics of FHIR technology, check out Toehold Learning’s in-depth technology guide.

1. Unlocking the data

Accessing discrete data elements can be difficult, or in some cases impossible, with most healthcare applications currently used in healthcare facilities. Some programs simply can’t access certain data elements in other systems—especially when legacy systems interact with the hottest new tech. To make the data accessible to other applications, they must be extracted, transformed, and loaded into other data repositories. Alternatively, the programmer needs to know the complex schema for each source system and then compose detailed SQL requests. This has been the standard practice for so long that it has just become accepted—universally detested, but accepted as the IT world in which we live.

FHIR will begin to change the healthcare IT ecosystem by unlocking the data. The latest standard from the HL7 Standards organization, almost all electronic health records (EHRs) and many other clinical software vendors now support FHIR. A FHIR server allows direct access to discrete data such as a patient’s gender, birth date, diagnostic test results, or medication dispensed. Programmers don’t have to wait for the data to be moved to a separate data store using common code libraries before they can get at the data. Instead, the FHIR system is much more straightforward. Programmers compose a specific targeted request as a URL and then send it to the server. The server then returns the results. A simple query and results process provides each data element needed from the original source system.

Healthcare IT has been plagued by needing redundant data stored in multiple locations. We needed the redundancy to make interoperability between systems possible, or to allow new functionality beyond that which the vendor supplied. FHIR reduces the complexity of keeping all these systems in sync, thereby reducing costs by eliminating redundant storage and CPU resources. FHIR unlocks the data inside the source system, a major win for healthcare IT systems administrators and the care providers who need to access these data.

2. Expanding the developer pool

Another major problem with healthcare IT is that there are far too few healthcare applications programmers. This means that the labor force tends to be expensive and in short supply. Two solutions to this shortage are possible. We could either train more programmers on the intricacies of traditional healthcare interfaces, or change the tool set to match the skills of today’s programmers. Thanks to FHIR, the latter path is now possible and is the one that much of the industry is taking. New tools are rapidly becoming available to develop innovative solutions, and with these new tools many new possibilities have arisen.

One of the many benefits of FHIR is that this standard opens up the field of available programmers by using common languages and protocols. FHIR uses current standards like REpresentational State Transfer (RESTful) interfaces and coding standards XML syntax and Javascript Object Notation (JSON). Students today learn REST, XML and JSON in school, and these programming tools are well known to the modern generation of programmers. Because FHIR uses these common languages and syntax, literally hundreds of thousands more programmers than ever before can now collaborate on healthcare projects through FHIR.

FHIR will enable rapid prototyping and development of new FHIR-based apps by allowing large numbers of programmers to use tools they are familiar with. App designers and programmers can try out new ideas without the weeks of development that the old tools required. Putting a trial solution in the hands of users allows for much better collaboration between user and developer, resulting in much better solutions. Seeing the ideas in action and then improving on them generates outstanding final products. This kind of iteration requires streamlined, accessible tools when other programmers need to make changes later in the development and maintenance of the application.

3. Controlling your facility's future through FHIR

Put simply, purchasing and implementing systems with a FHIR interface may be crucial for the future of your organization.

Operational partners know the tasks they perform today and can picture how new products will impact performance. But what about the requirements five years from now? Traditionally, the ability of a system to meet a facility’s future needs depends almost exclusively on the vendor’s roadmap and time frame. Sadly, this tends to put the facility at the mercy of the vendor. And, as we know from the old adage: the best laid plans of mice and vendors often go awry! FHIR-based systems allow leaders to control a facility’s future roadmap by leveraging other app developers and the organization’s own programming staff. With FHIR, you can chart your own course.

We’re all familiar with the iOS App Store and the Play Store for Android. They are awesome precisely because we humans don’t all want to use their phones and tablets for the exact same purposes. FHIR and SMART on FHIR are helping to bring this flexibility to healthcare facilities. Because vendors like Cerner, Epic, and Athena support FHIR, they allow for unique add-on functionality that each facility and provider community may need. The EHR can be tailored with FHIR apps that provide the exact functionality that each health system needs to deliver care, today and in the future. Vendor-agnostic solutions, based on FHIR, can be built over the top of most EHRs. This creates a huge market that will encourage the development of several different approaches to solving the same problem. A FHIR-based future removes the pressure of being forced to use the one approach offered by the core system whether it meets all your needs or not.

The best laid plans of mice and vendors often go awry! FHIR-based systems allow leaders to control a facility's future roadmap by leveraging other app developers and the organization's own programming staff.

-John Ulett, VP @ Toehold Learning Tweet

Healthcare IT needs and a FHIR-enabled ecosystem

As the three main points above show, FHIR holds significant potential to positively impact the world of healthcare IT. The entire industry needs all (or most) software vendors to adopt FHIR to reach the full potential of these standards. Thankfully, the ecosystem appears to be heading in that direction. Healthcare CIOs, IT leaders, and operational leaders need to understand the broad and deep benefits that come from selecting products that provide FHIR integrations. We all would do well to keep FHIR in mind for both the present and future of our facilities.

Ultimately, many of the major innovations we see on the horizon in healthcare, like precision medicine, will remain unavailable to most people unless we solve the problem of healthcare interoperability. To continue improving interoperability, we also must work collaboratively with developers to extend the utility of EHRs and other IT systems. The best solutions arise when teams of providers, tool-enabled developers, and innovative leaders join together to change what is possible in healthcare delivery.

Author: John Ulett

John Ulett is the VP at Toehold Learning. He has over thirty years experience working with innovations in software technology, and eighteen spent in the healthcare industry. John’s experience provide him a unique perspective on the challenges of integrating new technologies into the framework of existing healthcare technologies.

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