Fire_from_brazier

A fair number of our clients have been asking about FHIR lately so it’s time to fan the flames a bit and shed some light on this developing interoperability standard. FHIR (which is pronounced “fire”) is a methodology that was developed based on the standards from the HL7 organization, a non-profit. It stands for Fast Healthcare Interoperability Resources. Essentially, FHIR is a universal translation tool that will permit the exchange of clinically-relevant data to be shared securely and more easily. Currently, when data is shared among disparate systems, there are limitations to what can be ingested into the system and often the information is trapped inside documents like PDFs that do not become fully integrated into the patient’s incoming chart.

One of the most interesting developments around FHIR is that many EHR vendors have agreed to support the concept and put efforts into implementation. Several of these vendors include industry leaders such as athenahealth, Cerner and even Epic, a system not particularly well-known to share freely with other EHRs.

It is important to note that FHIR is not yet a mandatory standard and vendors are free to adopt or ignore it at this time. Whether or not it succeeds in the goal of unifying clinical information exchange depends on a number of factors:

Fueling the FHIR:
1. Idealism. True interoperability is the right thing to do — providing a complete clinical picture of the patient improves quality of care and reduces needless time-consuming tasks for the patient, health systems and medical offices.
2. Apps. The market for applications that can be used across any and all EHRs will expand so industry pressures from outside the EHR vendors will help push adoption.
3. Regulatory. Government, regulatory agencies and payors may require FHIR adoption and tie its use to incentive-based payments. Following the money, this will advance the use of the standard.

Mixed Results:
1. Divergence. The ability for users to move more easily from one EHR to another will make some vendors fearful of losing customers while others will jump at the change to migrate new users to their products.

Extinguishing FHIR
1. Time. Changing to new standards across so many vendors is not a quick or easy process. It will probably be several years before there could even be moderately widespread usage. In the meantime, something new or better may emerge which will overshadow the FHIR initiatives.
2. Evolution. FHIR is far from complete and improvements will have to be made. However, if you consider how often apps send updates and companies like Google and Apple improve their APIs, this is to be expected.
3. Fear. Health systems and providers may not be willing to share data as freely as interoperability standards might require. Often, this is out of fear of leakage, or the loss of patients to another system or provider.

Interoperability is not just a technical problem of connecting pipes and watching the information flow. There are change management, financial, and strategic issues at play that must be properly handled. And though the government may step in and force the hand of vendors and providers, eliminating many of the choices, being prepared for multiple eventualities and planning in advance will help payers, providers and vendors position themselves for the future.

Strategic Interests has expertise in past, current and future interoperability standards including strategic planning, implementation and deployment. If you have questions or concerns about FHIR or other interoperability situations, let us help you plan your roadmap for success.