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The Technology Behind Successful Interoperability

FHIR - Blog-07

It is increasingly evident that Interoperability is going to be a necessary function in the context of healthcare reforms to achieve triple aim (Care, Health and Cost). The new models evolving around value based care necessitates to equip the providers with all the information about the patient to treat effectively in the continuum of care. The disparate information systems used by these providers across the enterprises virtually need to be connected to make the patient data 2 way interoperable.

It is imperative for the connected systems to make the patient data available meaningfully at the point of care decision that could change the treatment outcome positively and improve the quality of care. Before the data is exchanged, it has to be normalized and standardized in source-agnostic format enabling achieve easy interoperability. The semantic data organization also allows clinician to quickly understand the true meaning of data from multiple disparate systems.

With the fact that the Patient health information is spread on multiple care settings, It is important to use standard-based connectivity routes for interoperability without building expensive and time consuming point to point interfaces across the enterprises. Clinical documents exchanged need to follow established document standards like CCR and CCD or futuristic standard like FHIR( pronounced “fire”) to make interoperable quickly across the enterprises. Bigger EMR vendors are quickly adopting FHIR standards in their products enabling the peers and partners in the ecosystem boosting further innovations.   But before we talk about the power of FHIR, let’s go the very beginning.

Evolution of interoperability leading to FHIR

Most of the current interoperability standards and frameworks today heavily rely on query/retrieve based model. That model is not well fitted for longitudinal patient record that logically gets created by the health care providers community in the continuum of care over the years.  When the patient is in the office for a visit, a primary care provider might only query HIE for that part of the care information that was rendered outside the office. After visiting their PCP, patient might see a specialist who may order some radiology or lab tests. Analytical tools used by the health systems would somehow want to query the specialists’ EMR to get the new information without triggering an event automatically. If you consider performing this operation several hundred times a day for all potential patients in the community, it is clear how a query/retrieve integration model necessitates innumerable volume of polling queries.

Current model of data exchange and interoperability using on the document architecture would allow providers to selectively pick and transmit the data. However, this may limit the holistic view required for  decision making at the point of  care and later followed by meaningful care coordination. On the other hand, when a physician request just one piece of information about a patient, the system often needs to transfer multiple document to fulfill the request. This approach again may be inefficient for the provider to search through many pages of information just to find one piece of data.

FHIR Subscription model

It appears that the new integration push model FHIR(Fast Health Interoperability Resources, pronounced “fire”) can solve this problem. It was created with the complexity of healthcare data in mind and internet based approach to connect various discrete elements. FHIR is a specification from standards developer HL7.org that outlines how to support an application program interface (API) for the purpose of exchanging data among healthcare IT systems. Data elements, or “resources” each have a tag that acts as a unique identifier, just like the URL of a web page. It’s prime goal is to provide web-based access so that the relevant patient data elements can be extracted for practical clinical use, rather than the ongoing exchange of larger and most likely repetitive and redundant polling for the possibility of updated information in the patient chart.

FHIR is attractive primarily because it is based on a truly modern web services approach (and one used by companies such as Yahoo, Facebook and Google). This approach makes it easier for systems to exchange very specific, well-defined pieces of information, rather than entire documents. The power of FHIR lies in the underlying model of subscription where a client can tell a server to automatically push new and updated data that matches some criteria. This model takes the full advantage of server’s capability required for searching. This model also gives clients an ability to post complex queries required for their use cases and thus avoid the need for custom development. Users across the internet can access the same URL and complete the same tasks using any standard browsers running on any web enabled device, whether desktops or hand held running Apple, Windows, Androids or Linux operating systems.

FHIR promises to do the same thing – to allow developer communities to build standardized “browser” applications that allow access the data no matter what the underlying operating system or infrastructure that EMR runs on.  

To summarise it all for you, FHIR represents a major opportunity to accelerate healthcare data interoperability across a wide range of currently disparate systems. FHIR  attempts to provide more seamless connectivity standard. The proposed standard represents a smarter way to use technology by building on what is already in place while also providing the flexibility to meet future business needs.

FHIR is not simply adding additional standards to an already overflowing kettle, but rather the next step in the evolution of standards that will truly promote interoperability. Ultimately, FHIR may become a critical technology driver for increasing health care quality, increasing patient access and use of health information and improving outcomes.

Adi Sesha

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