FHIR’s normative stage only months away; EHR vendors planning to use it

Industry stakeholders are starting to see light at the end of the interoperability tunnel, as major electronic health record vendors look to incorporate HL7’s emerging Fast Healthcare Interoperability Resources (FHIR) standard in their products.

With the normative version of FHIR slated for release in the spring of 2017, vendors are expected to soon implement the application programming interface (API) in their EHR systems, say observers.

The normative version of FHIR that will be available next year will be stable enough for large vendors to incorporate it into their platforms, asserts Chuck Jaffe, MD, CEO of HL7, speaking at last month’s Workgroup for Electronic Data Interchange Annual National Conference in Salt Lake City.

“I would be very surprised if we didn’t have some of the major EHR vendors with some type of meaningful FHIR-based functionality released in their systems next year,” says Micky Tripathi, CEO of the Massachusetts eHealth Collaborative and manager of the Argonaut Project, an industry-wide effort to accelerate the development and adoption of FHIR.

“There’s a lot of good hope and promise about FHIR developing as a standard and getting to maturity perhaps a little bit faster than we might have originally thought,” Tripathi adds.


According to Tripathi, the strength of the Argonaut Project is the fact that there has been tremendous support for the initiative with strong engagement and collaboration from its testing community of about 80 providers and vendors—including EHR rivals Cerner and Epic—participating in a series of “test sprints” conducted in two- to three-week intervals, which are scheduled to run throughout this summer, leading to the release of the normative version of FHIR next year.

John Valutkevich, MEDITECH’s manager of interoperability initiatives, says his company is currently in the process of leveraging its experience as a member of the Argonaut Project to incorporate FHIR-based support into the vendor’s product, starting in 2017.

“We have found our membership as one of the founders of the FHIR-Argonaut Project invaluable,” says Valutkevich. “Anything that’s required for the patient engagement, API piece is what we’re turning out now in part of our sprint efforts within Argonaut.”

While Cerner points out that HL7 has not announced a “formal release date” for the normative version of FHIR, the company said in a written statement that it is “fully committed” to FHIR.

Similarly, Epic could not detail product roll-out plans tied to the emerging standard, but stated that its commitment to FHIR is firm.

“As each new version of FHIR is released, it becomes a top priority in enhancing Epic’s existing FHIR development,” said Danielle Friend, lead FHIR developer at Epic. “The exact timing of when we incorporate the new version of FHIR into our EHR depends on myriad factors, such as the complexity and industry demand of the new standard, compared to previous versions. Given this, we typically determine our development timeline closer to the actual release of the new version of FHIR.”

A next-generation standards framework, FHIR leverages RESTful APIs and OAuth-based security to enable data sharing among a plethora of health IT systems. By using the latest web standards, FHIR is seen as a simple-to-use format that can improve interoperability for a range of HIT technologies, including mobile apps, cloud communications and EHR-based data sharing.

Speaking at last week’s ONC Annual Meeting in Washington, David McCallie, MD, Cerner’s senior vice president of medical informatics, said the exciting thing about the FHIR API-based technology is that it can coordinate medications, allergies and other complex pieces of data that in the past could be exchanged only through products from a single vendor.

“It’s been very gratifying to me to see the vendor community, in partnership with some of our major clients, come together to refine the FHIR APIs and profiles, which are the rules on how you put the data into the fields that are defined in a FHR message,” McCallie said. “It’s the tedious, iterative work that’s necessary to get close to semantic interoperability. You’d be amazed at how hard it is to get agreement on how to send blood pressures back and forth between systems. You’d think that would be easy, but it’s not because everybody does it a little bit differently.”

Marc Probst, chief information officer at Intermountain Healthcare, told the audience at last week’s ONC Annual Meeting that what the industry needs is “completely semantic interoperable data” that can be used to improve healthcare. “There’s a big gap between where we are today with interoperability and where I think we need to be,” he said.

Probst added that Intermountain is an active member of the Argonaut Project, and he is encouraged by the progress being made with FHIR. “We really need to get to some standards on how we’re going to do this,” concludes Probst, who contends that, ultimately, interoperability will save the healthcare industry billions of dollars and hundreds of thousands of lives.

Still, Jaffe is quick to reassure providers that legacy health data is not going away in a FHIR-enabled environment. “If you can get your lab results quickly and accurately, that’s not going to change. But where it will change is, as we have new kinds of information we need there will be new kinds of sharing requirements,” according to Jaffe.

Towards that end, APIs were included in the recently issued final Meaningful Use Stage 3 rule, requiring certified EHR technology to provide an API through which patient information can be viewed, downloaded, and transmitted to a third party. In addition, APIs are part of the 2015 Edition of Health IT Certification Criteria which requires certified EHRs to demonstrate the ability to provide a patient-facing app access to the Common Clinical Data Set via an API. The Argonaut Project FHIR implementation guides support the 2015 Edition API requirement.

“ONC continues to talk to HL7, the Argonaut Project and others about how they can support FHIR,” said HL7’s Jaffe. “We’re collaborating with ONC on the new rule, trying to understand where FHIR fits.”

For its part, McCallie said Cerner has a significant amount of work underway created by that regulatory demand, adding that the EHR vendor is “heartily in agreement with that requirement and have large teams of engineers working on tight deadlines to meet that deliverable.”

MEDITECH’s Valutkevich also said the pending Meaningful Use Stage 3/MACRA requirements are a major driver for the vendor, which has a goal of delivering FHIR-based functionality to its EHR customers in 2017.

Overall, McCallie believes that because of the Argonaut Project’s efforts to accelerate the development and adoption of FHIR, “we have a reasonable chance that, when we get there it will actually work.”

“We can’t make this happen if someone refuses to put data in a format that can be consumed,” declared Jaffe. “But, certainly we can create an environment and an ecosystem to support it.”

As McCallie points out, the Direct Project was launched in 2010 to specify a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet. However, he argued that what happened with Direct is a “case study in how it doesn’t work very well if you just specify that the standard has to be implemented, if you don’t have in parallel all of the infrastructure necessary to have a robust network.”

“With Direct in the early days, anyway, we didn’t have that,” observed McCallie. “Just putting the standard in and mandating its use did almost nothing.”

Likewise, Tripathi says the Argonaut Project has tried to avoid the mistakes made with the initial implementation of the Direct message protocols. “Thanks to a lot of market input along the way, we can be more sure than we were with the Direct standard that once FHIR starts to get fielded that it will actually work,” he predicted.

“I think most of us are really concerned about the marketplace, which will decide things that regulation never has done effectively,” concludes Jaffe.

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