FHIR to play crucial role in long-term TEFCA strategy

While the coding standard is still moving along a path to maturity, industry expects it to be fully ready when timeline specifies its use.

Healthcare leaders weighed in optimistically on the newly released federal Trusted Exchange Framework and Common Agreement, a plan to facilitate nationwide health information-sharing that will rely heavily on HL7’s Fast Healthcare Interoperability Resources (FHIR) standard within three years.

Mandated by the 21st Century Cures Act, the Trusted Exchange Framework and Common Agreement (TEFCA), creates the baseline legal and technical requirements that will enable secure digital health information exchange, leaning heavily on FHIR for data exchange.

The set of standards, including both a coding framework to automate information exchange, as well as bundles of pre-accepted coding that facilitate “use cases” or types of transactions, are in various stages of maturity and gaining widespread acceptance and being universally applied.

ONC National Coordinator Micky Tripathi said FHIR isn’t fully ready, but it will be by the time TEFCA’s roadmap for its incremental adoption is achieved. “[It’s] not at a point of maturity for network enablement,” he said at an event introducing TEFCA. “But that said, there are a number of networks across the country that are starting to either run pilots or actually starting to think about putting (FHIR capabilities) into production that would help with the scalability of a FHIR-based exchange.

“Most of the FHIR activity out in the market today is point to point, using FHIR APIs, and scalability of those is hard,” Tripathi said. The problem becomes how to locate where records are so that an end user knows which points to connect.

In writing TEFCA, ONC framers tried to focus on where FHIR is mature and asked, “How do we help energize that and help to scale that as quickly as possible; and then how do we accelerate the maturity of it for network-level exchange, where it's least mature right now?” Tripathi said.

Don Rucker, MD, chief strategy officer for 1upHealth and former ONC national coordinator, says he would “bet his post-ONC career that we are in our next step of interoperability.” He said the nation has to move past merely exchanging data to using it to improve population health, and he believes the TEFRA roadmap for FHIR will serve as an important steppingstone.

Lee Barrett, CEO and executive director of the Electronic Healthcare Network Accreditation Commission (EHNAC), has no doubts that FHIR will be ready. “There's been tremendous work…on the part of the HL7 community, the Da Vinci Project, ONC and all the various players,” said Barrett of EHNAC, a non-profit standards development organization and accrediting body for electronic health data exchange, which is also a leader for two of ONC’s FHIR task forces.

“Where we are today and where we're going to be, probably another year from now, is exponential in relation to growth in our ability to scale and to move forward with really operationalizing interoperability for the healthcare ecosystem,” he added.

HL7 CEO Charles Jaffe, MD

Tony Sheng, vice president of Interoperability Solutions for ZeOmega and a member of HL7’s Da Vinci Project, says FHIR will be ready because of strong industry engagement and regulatory support. “Our clients have FHIR on their internal roadmaps, and there are numerous groups which have been working on the required network level services over the past few years,” he said. “The FHIR Roadmap for TEFCA lends further support by providing leadership and guidance for stakeholders to align their internal FHIR roadmaps with added confidence.”

Sheng sees the need for a more scalable way for connecting FHIR endpoints. “This will be overcome through network-level services such as directories and identity management, with testing and accreditation programs to ensure conformance,” he says. “As these evolve, I believe our thinking will naturally shift from ‘connection’ to ‘network.’ ”

TEFCA’s bottom line is to improve patient care, according to Charles Jaffe, MD, CEO of HL7. The facilitated data exchange will ultimately reduce the burden on physicians, decrease cost of care and increase efficiency. When FHIR version 5 is realized, the difference in the nation’s ability to exchange healthcare data “will be magnificent,” he said.

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