Some High Level Perspectives on FHIR

Before HIMSS, I posted about my work to understand FHIR. There’s some great information in that post as I progress in my understanding of FHIR, how it’s different than other standards, where it’s at in its evolution, and whether FHIR is going to really change healthcare or not. What’s clear to me is that many are on board with FHIR and we’ll hear a lot more about it in the future. Many at HIMSS were trying to figure it out like me.

What isn’t as clear to me is whether FHIR is really all that better. Based on many of my discussions, FHIR really feels like the next iteration of what we’ve been doing forever. Sure, the foundation is more flexible and is a better standard than what we’ve had with CCDA and any version of HL7. However, I feel like it’s still just an evolution of the same.

I’m working on a future post that will look at the data for each of the healthcare standards and how they’ve evolved. I’m hopeful that it will illustrate well how the data has (or has not) evolved over time. More on that to come in the future.

One vendor even touted how their FHIR expert has been working on these standards for decades (I can’t remember the exact number of years). While I think there’s tremendous value that comes from experience with past standards, it also has me asking the question of why we think we’ll get different results when we have more or less the same people working on these new standards.

My guess is that they’d argue that they’ve learned a lot from the past standards that they can incorporate or avoid in the new standards. I don’t think these experienced people should be left out of the process because their background and knowledge of history can really help. However, if there isn’t some added outside perspective, then how can we expect to get anything more than what we’ve been getting forever (and we all know what we’ve gotten to date has been disappointing).

Needless to say, while the industry is extremely interested in FHIR, my take coming out of HIMSS is much more skeptical that FHIR will really move the industry forward the way people are describing. Will it be better than what we have today? I think it could be, but that’s not really a high bar. Will FHIR really helps us achieve healthcare interoperability nirvana? It seems to me that it’s really not designed to push that agenda forward.

What do you think of FHIR? Am I missing something important about FHIR and it’s potential to transform healthcare? Do you agree with the assessment that FHIR very well could be more of the same limited thinking on healthcare data exchange? I look forward to continue my learning about FHIR in the comments.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

8 Comments

  • To me FHIR is en evolutionary standard, but not in and of itself a game changer.

    The question to me is: are we 9all of us, the industry, the healthcare providers) able an willing to have a new type of interoperability? Is the trend towards Open APIs, VNAs and BYOD something that’ll stick?

    If your answer to that question is a yes, then FHIR is a suitable standard to deal with those issues, whereas some of the earlier standards are not. Should your answer be no, then no standard will be able to change that. Interoperability standards follow the requirements of the real world, standards don’t determine how things happen in the real world.

    That at least is what I’ve learned from documenting the early history of HL7v2 ( http://www.ringholm.com/docs/the_early_history_of_health_level_7_HL7.htm ). I am convinced that the trend towards Open APIs (opening up the data siloes, for Analytics, to support BYOD, to support Vendor Neutral Archives, to support patient and provider portals and apps) is something that’s here to stay.

  • Rene,
    I’m still trying to figure out if the trend you mention is going to stick or not. I’m hopeful that it will, but I can see some reasons why it could be hijacked.

    I’m still digging into whether FHIR is a suitable standard for the trends you mention. A part of me thinks that it may not go far enough.

    You’re right about standards not being the solution if the industry doesn’t want to go that direction. Very insightful comment. Thanks for sharing.

  • FHIR is completely different from previous standards because it’s not entirely controlled by the healthcare industry. Properly managed, it will solve the interoperability problem with privacy and joy. However, as with previous attempts to introduce Internet standards into healthcare FHIR can be derailed to support the information blocking and information sale interests of the current data holders. Remember Direct? It was supposed to be just secure e-email for everyone with a Federal certificate until powerful incumbent forces broke it.

    FHIR is based on modern Web standards for Application Programming Interfaces (API). The FHIR APIs are, by design, policy-neutral and could replace the existing menagerie of obsolete healthcare interfaces including the ones that feed data brokers, research, apps, Direct, and even Blue Button+. This could be a huge boon to privacy and accountability as was demonstrated at HIMSS by a pilot of the VA, HHS ONC, and Patient Privacy Rights called Privacy on FHIR. Here are some slides from the Interoperability Showcase presentation http://www.slideshare.net/agropper/himss15-privacy-on-fhir-r4

    For more on this concept, read the JASON reports. They clearly call for a Public API to be part of Meaningful Use. Let’s hope the regulators and industry are finally fed up with information blocking and security theater and implement modern technology that makes patients and physicians first-class citizens in health information access. For more, on the Public API and MU, see my post: http://thehealthcareblog.com/blog/2015/04/16/last-chance-for-meaningful-use/

  • FHIR is a simplification of the HL7v3 standard that does help vendors understand and implement data exchange. It allows for atomic data transactions and is core to the CommonWell Alliance as the document broker framework. So I believe it is well positioned to accelerate the exchange of information and will be well adopted over the next 3-5 years IMO. I think baby steps and incremental improvements are key to moving the needle in HIT, so I am cautiously optomistic.

  • Let’s not forget the push for Open APIs is not unique to the US, on my side of the pond NHS England has defined an “Open API Architecture policy” (http://www.england.nhs.uk/wp-content/uploads/2014/05/open-api-policy.pdf), and Germany has a draft law “e-Health Gesetz” out for comment which also requires Open APIs. I’m fairly sure there are other examples out there.

    And yes, the NHS is more of a top-down healthcare environment paid for by taxes, but Germany’s healthcare stucture certainly isn’t. Even if there’s legislation and/or incentives progress will be slower than what we’re hoping for.

  • Thanks everyone for joining in on the conversation.

    Adrian,
    I’d love to hear your thoughts on how we can prevent the data holders from hijacking FHIR. Also, I can see how it’s better from a security, privacy and flexibility stand point, but how about from a data access stand point?

    Tom,
    It seems that healthcare can only stand baby steps. So, maybe FHIR is the right baby step, but is it wrong for me to desire more?

    Rene,
    Thanks for keeping the discussion international. I’d love to learn more about what Germany has been able to accomplish since you’re right that it has a model that is complex like the US one.

  • The only way to prevent incumbent data holders from hijacking FHIR is to treat patient access to the FHIR API as a civil rights issue. HIPAA gives patients a right of access. It’s now up to OCR to provide guidance and enforcement of both access and accounting for disclosures around FHIR and other APIs.

    Read my THCB post I referenced above for specific Stage 3 MU references.

    Adrian

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