How Fast Interoperability is Speeding Innovation in Healthcare

Scott Mace, June 6, 2016

Healthcare leaders at Boston Children’s Hospital, DukeHealth, and Intermountain Health find that Fast Health Interoperability Resources aids in the flow of discrete data and clinician workflow.

This article first appeared in the June 2016 issue of HealthLeaders magazine.

An unlikely trio—a children’s hospital, an academic medical center, and a regional hospital system just converting from a home-grown enterprise EHR to a commercial one—is blazing a trail that is beginning to allow data to flow in discrete bits to spur innovation and interoperability across all of healthcare.

The three—Boston Children’s Hospital, DukeHealth, and Intermountain Healthcare—are among the first in the nation to implement new HL7 technology known as Fast Health Interoperability Resources, or FHIR, not just for new patient data access options, but to enhance clinician workflow and decision support.

Shafiq Rab, patient data, EHR, FHIR, interoperability
Shafiq Rab

On the patient data access front, a fourth player, Hackensack University Medical Center, part of the four-hospital, 1,717-licensed-acute bed Hackensack University Health Network, was one the first implementers of FHIR, with its own patient-facing app interfacing with the Epic EHR, late last year.

“We are requesting and encouraging vendors to adapt to FHIR, or it will become difficult to work with Hackensack,” says Shafiq Rab, MD, vice president and chief information officer of Hackensack UMC.

One element of the Centers for Medicare & Medicaid Services’ EHR incentive program updated in October 2015 is spurring interest and development in FHIR and other application programming interfaces (API). According to CMS, requiring 2015-certified EHR software to support these APIs will “enable the development of new functionalities to build bridges across systems and provide increased data access.

This will help patients have unprecedented access to their own health records, empowering individuals to make key health decisions.”

Even though such certified software will not be required to be in use until 2017 at the earliest, EHR vendors such as Cerner, Epic, and others have already implemented several FHIR interfaces in the EHR software they are currently shipping, with more interfaces, known as FHIR resources, being added throughout this year.

Fundamentally, FHIR allows developers to query, fetch, and potentially update discrete data elements from EHRs. Prior to FHIR and other API approaches, developers had to deal with less granular Consolidated Clinical Document Architecture (C-CDA) formatted data, creating application development and privacy challenges, says Josh Mandel, lead architect at Boston Children’s Hospital and Harvard Medical School.

In addition, HL7 made the FHIR specification freely available—a change from the days when downloading the C-CDA specification required that fees be paid to HL7, Mandel says.

At Boston Children’s, Mandel’s initial focus, which predated FHIR, was a project called SMART, which stands for Substitutable Medical Applications and Reusable Technologies. SMART is a method to create applications to be written once and run unmodified across different healthcare IT systems, capable of being launched from an EHR, and bringing information from that EHR, such as a patient’s demographics, into an app that extends the capabilities found in the EHR.

“There was a real disconnect between what we needed to do as clinicians and what the systems were set up to allow us to do,” Mandel says.

In 2010 the HHS Office of the National Coordinator for Health Information Technology funded $15 million over four years to develop SMART. In 2013 Boston Children’s updated SMART to take advantage of HL7’s FHIR standard, including its data model representation of EHR and other health IT data as FHIR resources. The result: Application development accelerated.

“Rather than focusing on low-level data, we decided to focus on the user experience” of running SMART on FHIR applications, some of which present themselves to users as part of the overall EHR experience, and others of which can run in the background, querying and updating EHRs or other healthcare IT interfaces such as analytics dashboards, Mandel says.

SMART on FHIR is architected to allow developers to swap out one app for another if the newer app is superior, he adds.

“The story is not as simple as saying your vendor will give all this to you, and the new features will just roll out and you won’t have to negotiate for them and you’ll just have all this,” Mandel says.

“Early on, it’s going to be those organizations that understand the value and are willing to push for it, that will benefit first.”

Scott Mace

Scott Mace is the senior technology editor at HealthLeaders Media.


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