Fast Healthcare Interoperability Resources (FHIR) from standards development organization Health Level Seven is gaining momentum as an open healthcare data standard.

That is the consensus of a joint Health IT Policy Committee and Standards Committee task force. The committees advise federal agencies.

In a Sept. 3 HITPC meeting, David McCallie and Micky Tripathi, co-chairs of the JASON Report Task Force created to analyze interoperability recommendations by an independent group of scientists, made the case that the “growing industry adoption of standards-based [application programming interface] work such as HL7 FHIR, focused on high-value use cases, is the most appropriate and sustainable path to accelerated use of standardized data-level APIs across the industry.”

The JASON report, which concluded that the lack of interoperability among data resources for electronic health records is a major barrier to information exchange, called for development and adoption of published, standards-based APIs and data models for documents and atomic data. The report recommended the government establish a “comprehensive, transparent and overarching software architecture” that would create an open, interoperable health data infrastructure. Specifically, the authors urged moving beyond the consolidated clinical document architecture (CCDA) supporting summaries of care to data-level “public” APIs to support the goals of exposing discrete data for improved clinical and research uses. They also proposed accelerating this development through regulatory requirements in Stage 3 meaningful use.

While “FHIR Profiles offer a promising approach to meeting the demand for ‘semantic interoperability’ and thus minimizing the need for ‘metadata translation services’ denoted by JASON,” states the task force’s draft recommendations, at the same time “there is much work to be done before FHIR can become a standard mature enough for large-scale deployment.”

The task force’s preliminary recommendations advise that CCDA refinement (document-encoding standards) and FHIR (for data-level standards and standards-based APIs) “should be targeted and accelerated through ONC contracting with existing initiatives and [standards
developing organizations] for development of tight specifications and implementation guides focused on high-value use cases and licensed for public use.”

ONC should encourage rapid public/private experimentation and iterative improvement processes with these emerging APIs to ensure that they work as intended, the task force argues in its initial recommendations. These experiments should include uses targeting clinical care, research, population data, as well as exposure to consumers via EHR portals, according to the task force.

In parallel, the task force sees the need to further refine document-level CCDAs to enhance their usability in an open API architecture. “Data-level APIs are not a replacement for structured document-level CCDAs, which capture encounter-level context that is critical for clinical care, as well as the narrative details that cannot be captured in structure,” states the draft recommendations. “Thus, there is an ongoing need to aggressively improve existing CCDA standards while working in parallel towards complementary data-level APIs.”

The task force will present its final recommendations in October. 

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