There’s a new software standard for sharing health data that’s gaining a lot of interest and support. Still in “prototype” format, it’s called Fast Health Interoperable Resources or FHIR (pronounced ‘fire’) and the early interest is more than just curiosity. Several high profile projects ‒ including the new CommonWell Health Alliance ‒ are actively testing the new software framework.
The reason for all the excitement is relatively easy to understand ‒ even if you don’t care to understand anything about software in healthcare. In a nutshell, many of the “behind‒the‒scenes” software standards and techniques that we all take for granted as part of our online web experiences (like shopping, travel and banking) are making a kind of formal debut in healthcare.
FHIR is the “HTML” of healthcare. It’s based on clinical modeling by experts but does not require implementer’s to understand those details. Historically healthcare standard were easy for designers and hard for implementor’s. FHIR has focused on ease of implementation. John Halamka ‒ CIO at Harvard and Beth Israel Deaconess Medical Center
A summary introduction (here) offered a list of the benefits which included these:
- Specification is free for use with no restrictions
- A strong focus on implementation – fast and easy to implement (multiple developers have had simple interfaces working in a single day)
- Strong foundation in Web standards – XML, JSON, HTTP, Atom, OAuth, etc.
- Support for RESTful architectures and also seamless exchange of information using messages or documents
FHIR’s humble beginnings were forged out of a frustration with existing standards that were overly complex and brittle. It was first proposed in July of 2011 and the broader interest has grown quickly ever since.
“We started work on FHIR out of frustration with the complexity and unwieldiness of the existing healthcare standards, and because we could see wonderful things happening on the web. Our goal is to drive down the costs of exchanging data, to set the healthcare information free so that people can solve real world healthcare problems more easily and cheaply. FHIR has grown into a very capable standard that’s still really simple to implement, and we’re thrilled by all the excitement that it’s created.” Grahame Grieve ‒ FHIR Project Lead
The excitement was clearly evident at this year’s annual Health IT event called HIMSS (Healthcare Information and Management System Society) which was held last month in Orlando.
With no less than 41 sessions on the topic of interoperability (list here), the 2nd Annual Interoperability & Standards Committee Networking Breakfast and Panel (here) was notable for its exclusive focus on FHIR and the expert panel assembled for the discussion.
- Grahame Grieve ‒ Principle Developer of FHIR
- John Halamka ‒ MD, MS, CIO at Harvard and BIDMC (remotely)
- Dave McCallie, Jr. ‒ MD, SVP of Medical Informatics and CMIO, Cerner
- Doug Fridsma ‒ MD, PhD, Chief Science Officer, Office of the National Coordinator
- Wes Rishel ‒ Vice President and Distinguished Analyst, Gartner
- Charles Jaffe ‒ MD, CEO of Health Level Seven International (moderator/host)
The 60 minute panel ‒ sponsored by HL7 ‒ is now freely available online here.
Wes Rishel used a makeshift Gartner Hype Cycle (recreated here) to position what he sees as FHIR’s current status.
Even though Wes positioned FHIR at the “Peak of Inflated Expectations,” he was quick to point out that this was largely due to it’s rapid evolution since there are no “live” installations of the technology. On its current trajectory to Gartner’s enviable “Plateau of Productivity,” Wes was very bullish:
“I look forward to that happening much more rapidly with FHIR than it has with most other technologies because it’s lightweight and it’s designed for this rapid cycle time and because Grahame and HL7 have really rethought how standards are developed and shared to make use of the modern technologies.” Wes Rishel ‒ Vice President and Distinguished Analyst, Gartner
One of the early adopters is a joint project between Harvard Medical School and the Office of the National Coordinator called SMArt (Substitutable Medical Applications, reusable technologies). With Grant Funding from ONC, the SMArt effort is (according to John Halamka here) designed to “enable” the equivalent of the iTunes App Store for health.
“FHIR is a new effort, but health IT vendor interest is very real ‒ largely because FHIR builds on the tremendous success of RESTful APIs for the consumer and commercial web. The challenge for many vendors will be moving from cheerleading to actual use. There’s an aspect of technical challenge ‒ but the key challenges are operational. We’re still waiting to see real business commitments.” Josh Mandel ‒ Lead Architect for SMArt Platforms at Harvard Medical School
The CommonWell Alliance (announced at HIMSS last year here) is also experimenting with FHIR as a way to exchange health data across business and clinical boundaries.
“Cerner is always seeking ways to enhance interoperability and usability. We’re excited to help pioneer the ‘SMART on FHIR’ approach, which uses FHIR, an important new standard from HL7, in conjunction with the SMART platform work coordinated by Boston Children’s Hospital. Together, these will enable a host of new plug-in apps, which may be deployed by any compatible EHR. The apps will provide new modes of data sharing, and allow for unprecedented expansion of core EHR capabilities.” Dave McCallie, Jr. ‒ MD, SVP of Medical Informatics and CMIO, Cerner
Software’s capacity to transform industries continues to be an amazing story, but much of the online user experience is reliant on shared data and resources. Healthcare continues to be the sizable exception. Here in the U.S., it’s why the lowly fax machine often remains the ‘lingua franca’ of health data exchange. FHIR has great potential to radically change that. As with all things in U.S. healthcare, however, the real trick will be keeping everybody focused on the collective benefits around patient safety, quality and care.