Electronic Health Reporter

By Patricia Hyle, vice president of product commercialization, StayWell.

Fast Healthcare Interoperability Resources or FHIR was introduced in 2014 as a data standard for electronic health records to adopt, enabling improved access in sharing health data. The move was predicated by new standards set for the with the passing of the Affordable Care Act in 2015 but supports the standard framework for EHR systems to ensure patient information be accessible in an effort to deliver quality care.

FHIR aims to simplify implementation without sacrificing information integrity. It leverages existing patient models to provide a consistent, easy to implement, and rigorous mechanism for exchanging data between EHR applications. This move gained ground when it earned support and adoption from Epic and Cerner, two of the largest EHR systems in the industry. With more than 80 percent of hospitals and health systems now using EHRs on the FHIR platform, it has become the standard for EHR vendors to meet ONC certification criteria.

Addition of apps to FHIR

Following the adoption of FHIR as the new universal standard operating platforms for EHR systems, the launch of SMART (Substitutable Medical Applications, Reusable Technologies) quickly followed to enable to launch of apps within the FHIR platform. When the two platforms came together it became known as SMART on FHIR, allowing software engineers and clinicians to create open-source tools for app developers.

With the addition of these plug-in apps, clinicians can pick and choose which apps they want to integrate into their EHR system. This allows apps to use the standard type of data to build profiles, deliver tools, create reminders, or share data within a fully connected set.

One example of this type of app on is Krames On FHIR. Launched in 2017, this app delivers recommended patient education materials based on inputs from the patient’s EHR record. The material also includes video resources, interactive tools, and health tips that can be sent directly to patients via the patient portal and provides a patient engagement dashboard that allows physicians to track engagement for greater treatment adherence.

Impact of consumer applications to FHIR

When SMART on FHIR initially launched, it was intended to be a set of app standards for developing apps within the closed FHIR network. The end user would be interfacing with an EHR system, and ideally the end user was a care provider or administrator in a health care setting. However, after a few years of use, more users and developers saw the potential use of extending limited access to the network to the patient.

With the most recent announcement by numerous tech and healthcare companies in support of the FHIR API data model, the FHIR network is further expanding its reach to the patient population. Expert app developers such as Apple and Google recognize the opportunity to connect users with their health data. Users will soon be able to manage their health and connect systems across platforms, tablets, mobile devices, and wearable technology, in the hopes of guiding treatment discussions and increasing personal health actions.

The Future on FHIR

FHIR and its growing library of SMART on FHIR apps continue to drive interoperability forward, especially with the integration of patient applications to better manage health data and provide a new set of inputs for physicians to reference. The addition of AI into health IT continues to make big advances for the ecosystem, and the new connected technology of wearable data inputs will further integrate into the EHR system.

While the support of Apple, Google, Microsoft, and other consumer-facing organizations have thrown support behind FHIR, and are opening apps to connect patients to the network, developers still recognize its primary use by health care providers. It’s unlikely there will be a rush of thousands of new apps flooding the market, as they are driven by use case rather than novelty like we’ve seen in consumer markets.

Following the first launch of apps on FHIR, we are now seeing next-level enhancements that allow better data on usage, knowledge retention, and engagement. Updates and upgrades are likely to permeate the future of FHIR as more developers bring greater innovation into the healthcare system, and further make patients an integral part of the healthcare team.