For a number of years, I have been in awe of the glacial pace at which healthcare has been creeping toward the interoperability of digital health information.
Rarely in the history of technology has so little come from so much investment of time, effort, money and talk.
This technology is not rocket science; interoperability has gone from what many have seen as too complex to implement to a common-sense, everyday necessity for the continuity of care. And yet, the large EHR vendors and some consultants seem to be invested in keeping providers in a state of perpetual confusion on the potential of tools such as Fast Healthcare Interoperability Resources (FHIR) and open APIs. The EHR vendors have deployed partial solutions, such as read-only FHIR APIs, but claim that more robust solutions are on hold while they are “in research mode.”
The truth is that vendors and healthcare providers are not having trouble with the technology, they are having trouble with the business case – principally the loss of control of their data silos and the limited ability to generate revenue from providing access to patient data.
To make the big players shift course and add FHIR capabilities to their systems is disruptive, but patients are demanding access, and value-based care cannot be effective without accurate and timely exchange of electronic patient data. We are at an inflection point, where the opportunity cost of not implementing a comprehensive, bi-directional open API such as FHIR to enable access to any authorized provider or patient exceeds the cost, process or security concerns delaying many implementations.
The fact is that open APIs have been allowing EHRs to fully communicate securely for some time now, meeting the latest data-exchange standards in affordable, user-friendly formats. Unfortunately, this gets lost in a blizzard of analyses, shifting regulations, legacy health information exchanges and the nature of competition in the vendor marketplace.
Making the case for delay even weaker is the publication of FHIR Release 4, a version that will be submitted to the American National Standards Institute as a normative standard, meaning that applications using the standard will have confidence that it won’t change significantly in the future, lessening the need for upgrades.
As just one example of readily available technology for FHIR, Carefluence has been helping to connect dissimilar EHR systems using open APIs since 2014, and its tools are easily accessed by anyone through the Amazon Web Service, Microsoft Azure and Google Apigee. The platform is fully compliant with the FHIR standard and can map its integration tools to any data exchange protocols. EHR vendors license its software and offer it to customers as a way of avoiding the costly development of a custom open API solution or having to be dependent on a particular vendor’s data exchange service model. Hospitals and medical groups use the software to avoid the disruptions and costs of EHR software upgrades just to be compliant with open API requirements.
Then there is the CDS Hooks initiative, which aims to allow providers to take advantage of the rush of CDS applications in development outside of the traditional electronic health record platforms. Providers seeking help with a clinical choice can execute a CDS algorithm without having to leave their EHR interface. This is interoperability in real practice.
The time is now to take advantage of these easily adoptable solutions. Regulations under the 21st Century Cures Act are moving forward to make adoption of health data exchange capabilities a necessity and to create a national “network of networks” to facilitate and standardize data exchange. There should soon be legal enforcement action over the practice of information blocking.
Beyond regulations, an affordable, accessible solution to interoperability for healthcare providers is needed to survive in an era of change in clinical practice. The ability to share digital patient information across clinical systems enables increased efficiency in care and improved clinical decision support, which are critical to success under value-based care. FHIR is key to leveraging innovation such as artificial intelligence and patient-generated health data for improved clinical decision-making. AI is being rapidly deployed by healthcare providers and demands accurate patient-level data in near real time – the more the better.
As a data-level standard that only calls for sharing the specific information resources sought by a related provider, the level of granularity in FHIR translation can quickly solve problems that used to require manual data extraction and normalization or trying to pick out information from a large body of text in a continuity of care document. A small but rapidly growing body of advanced analytics can be purchased on-demand, delivering services such as detailed clinical decision support (CDS), care planning apps, and patient engagement tools to streamline interactions with providers and administrative staff. These are examples of a much-needed commoditization of interoperability, which in fact is one of the stated goals of the Office of the National Coordinator.
The technology for sharing digital health information securely across disparate systems of care is not a pipedream. In fact, it has existed for years, hiding in plain sight, used by those willing to put the needs of the patient first and not succumbing to the limitations of a particular EHR vendor capability or timeline (it’s always going to be in the next release). Regardless of what comes out of Washington, with the plug and play interoperability solutions already available, there is vast potential of FHIR and open APIs to improve and integrate patient care.
Adam Boris is a veteran healthcare information technology executive. He is now a partner at TechCXO, an interim executive staffing and consulting company.