By Scott E. Rupp, publisher, Electronic Health Reporter.
The healthcare technology world is ablaze, on FHIR. New proposed standards for interoperability are being established to allow health systems the ability to share information and facilitate patient access to data. Specifically, in large part through a structure known as FHIR.
This “FHIR” the market is speaking of is Fast Healthcare Interoperability Resources, an interoperability standard for electronic exchange of healthcare information. FHIR was developed by Health Level Seven International (HL7), a not-for-profit that develops and provides frameworks and standards for the sharing, integration and retrieval of clinical health data and other electronic health information.
FHIR emerged in 2014 as a draft standard for trial use to enable health IT developers to more quickly and easily build applications for EHRs and to exchange and retrieve data faster from applications. FHIR soon received support from EHR vendors like Epic, Cerner and AthenaHealth. Shortly thereafter, the Argonaut Project emerged to move FHIR forward, and in February 2017, FHIR became a full data exchange standard.
FHIR is interoperability
FHIR is built on the concept of interoperability and modular components that can be assembled into working systems to try to resolve clinical, administrative and infrastructural problems in healthcare.
FHIR provides software development resources and tools for administrative concepts, such as patients, providers, organizations and devices, as well as a variety of clinical concepts including problems, medications, diagnostics, care plans and financial issues, among others. FHIR is designed specifically for the web and provides resources and foundations based on XML, JSON, HTTP, Atom and OAuth structures.
FHIR can be used in mobile phone applications, cloud communications, EHR-based data sharing and among institutional healthcare providers.
According to HL7, FHIR aims to simplify implementation without sacrificing information integrity. FHIR “leverages existing logical and theoretical models to provide a consistent, easy to implement and rigorous mechanism for exchanging data between healthcare applications. FHIR has built-in mechanisms for traceability to the HL7 RIM and other important content models. This ensures alignment to HL7’s previously defined patterns and best practices without requiring the implementer to have intimate knowledge of the RIM or any HL7 v3 derivations.”
Health sector buy-in
The healthcare sector has clearly bought into FHIR, primarily because of interoperability challenges.
“Sharing data between different health systems has required significant investment of IT resources on one-off projects,” said Nilesh Chandra, healthcare expert at PA Consulting. “As the needs for data sharing have increased, hospital IT departments have been swamped with demand for all of this custom integration.
“FHIR and similar standards are an attempt at standardizing data integration, to make it easier to connect EHR systems and easily extract or upload data into them, based on reusable IT components,” added Chandra. “That said, FHIR is an important step in the right direction, but is not the panacea for all health IT integration issues.”
FHIR uses a set of commonly used medical ideas termed as “resources.” The resources are used across many different types of companies and organizations, but can all mean the same thing. An example would be blood pressure readings, or an MRI scan. Those resources are held in EHRs, smartphones, health information exchange databases and so on. FHIR also allows for the mining of those elements since they are tagged in a similar way in the FHIR standard.
“The complex part is done by individual systems that don’t have the same operating system,” said Jason Reed, PharmD blog founder. “Because they can pull that tag then they pull it and exchange it with other entities. They only show the tag and not the other code or structures they had to use to get to that tag.”
While consolidated clinical document architecture allows a group of healthcare items to be sent together, this is essentially like sending an electronic PDF, Reed said. Other systems that have different operating systems can’t break that down unless they use the same operating system.
All of this is a culmination of the fact that digital health data can improve outcomes and lower costs, but the reality has been something less than ideal. For example, during the economic stimulus in 2009, systems were designed before modern web standards for storing and exchanging data were ubiquitous. The industry was caught in the middle of a technical revolution and spent its cash before the best new practices were available, said Nick Hatt, senior developer at Redox.
By Helen Waters, executive vice president, MEDITECH.
What would you do if you won the lottery? Regardless whether or not you play, you’ve surely pondered the question. Recently, during the frenzy around one mega jackpot or another, I had an interesting conversation with a friend. She told me if she were to win she’d replace everything she owned with the “very best” version of every item. When I asked how she’d know a product was the best, she told me she’d simply choose the most expensive option. In her thinking, she would have money to spare, and buying the products with the highest price tag would guarantee high quality. She admitted she might spend a little more than necessary, but she’d be able to afford it.
My reaction—which I didn’t express quite so bluntly—was, how wasteful and misguided!
As Americans we like to think that the market, uncorrupted by human influence, effectively sets prices for products and services that are in line with their value. But there are many reasons that markets don’t always work this way, particularly in the complex world of healthcare.
The more I thought about it, the more I realized that this kind of thinking guides some of the ways we make purchasing decisions in healthcare. Many patients, for example, feel that brand-name drugs must be superior to their generic counterparts—even when clinical trials demonstrate comparable effectiveness—simply because they’re priced higher and accompanied by persuasive advertising. Patients often lobby their physicians for expensive tests or procedures that have little to no evidence of efficacy for their conditions. And yes, even in our industry, otherwise-savvy executives can spend much more than necessary for healthcare information technology.
Over the past decade, the cost of electronic health record software and services has skyrocketed, far outpacing inflation and becoming untethered from real value. It’s understandable how this began, as the ARRA and HITECH Act infused cash into the market along with strong incentives to adopt the technology (as well as disincentives for falling behind). But those days are long gone. Hospital margins have continued to shrink. To the best of my knowledge, no healthcare facility has won the lottery lately.
Whether you’re buying a new appliance, a new car, or a new EHR, it’s important to do your homework. Look at the data. Perform a real comparative analysis. This means more than simply perusing marketing literature, conducting feature comparisons, or reviewing anecdotal feedback. It means looking at outcomes. Unlike many other products, software is abstract. You can’t touch it or see it to assess its value. You need to evaluate the impact it has and the satisfaction levels of the organizations that use it.
Just like a good physician wants to see evidence of the benefits of a drug, procedure, or care protocol by evaluating patient outcomes, healthcare executives must demand proof that an EHR is improving clinical and financial outcomes at organizations like theirs. Some important questions to ask:
CommonWell Health Alliance announces the addition of five new members enhancing the association’s nationwide footprint, share of the EHR marketplace and diversity across the care continuum. MEDITECH, Merge and Kareo join as contributing members while PointClickCare and Surgical Information Systems (SIS) join as general members.
With the addition of these new members, CommonWell membership now represents 70 percent of the acute care EHR market and 20 percent of the ambulatory care EHR market. CommonWell membership also represents market leaders in imaging, perinatal, laboratory, retail pharmacy, oncology, population health, post-acute care and others across the care continuum.
“We know it takes collective experience and dedication to break down barriers to nationwide data exchange, so we are especially pleased to welcome these industry innovators to the CommonWell family,” said Nick Knowlton, Vice President of Business Development at Brightree and CommonWell Membership Committee Chair. “Each organization will contribute to our effort by providing a commitment to action and new perspectives for additional use cases that will help us accelerate our current deployment of real-world interoperability services.”
• MEDITECH is one of CommonWell’s largest members to join since inception. It provides fully integrated technology solutions for hospitals, ambulatory care centers, physicians’ offices, long term care and behavioral health facilities, and home care organizations. MEDITECH’s membership increases CommonWell’s share of the acute care market from 50% to 70%.
• Merge is a leading provider of enterprise imaging, interoperability and clinical systems that seek to advance health care. It offers solutions in radiology, eye care, cardiology, orthopedics and clinical trials—all of which provide the opportunity for CommonWell to develop new use cases across a broader spectrum of the health care continuum. Additionally, Merge has the most complete radiology solution on the market, from small-volume sites up to the largest practices and chains in the country.
“Merge embraces the opportunity to join CommonWell at a critical moment in health care,” said Steve Tolle, Chief Strategy Officer at Merge Healthcare. “Industry leaders must actively come together to make interoperability real, and the Alliance provides an effective platform for meaningful dialogue and collaboration to help chart the future trajectory of the health care industry.”
• Kareo brings more than 30,000 providers and 60,000 users of its cloud-based medical office software suite into CommonWell. As CommonWell continues to deploy services nationwide, Kareo’s ambulatory experience and reach will accelerate universal provider access to critical health care data.