Health Level Seven International’s Fast Healthcare Interoperability Resources has tremendous potential for the interoperable exchange of health information, but some industry watchers wonder if its use should be required to facilitate widespread information exchange.
The use of FHIR, an application programming interface, is gaining momentum among providers and vendors, but it may be too early to definitively require it as a mandatory part of health IT certification requirements, others contend.
The Office of the National Coordinator for Health Information Technology “or some government body should require the use of FHIR at some point—but not yet,” contends Stan Huff, MD, chief medical informatics officer at Intermountain Healthcare. “It would be premature to mandate it now because it’s just not ready. To do it arbitrarily now would be a big mistake.”
While still in its early stages, FHIR “has been identified as a rapidly emerging standard and is currently garnering the most industry-wide support to be adopted,” according to Kim Nolen, a member of the HIT Standards Committee and co-chair of the 2017 Interoperability Standards Advisory Task Force.
“It’s not a regulatory requirement. However, many leading EHR vendors are implementing FHIR to meet regulatory API requirements,” Nolen told last week’s joint meeting of the HIT Policy and Standards committees.
APIs, which enable a software program to access the services provided by another software program, are included in the 2015 Edition of Health IT Certification Criteria requiring certified EHRs to demonstrate the ability to provide a patient-facing app access to the Common Clinical Data Set via an API.
“I think what ONC did with the API requirements in the 2015 Edition is a good balancing act,” observes David McCallie, MD, Cerner’s senior vice president of medical informatics. “They said ‘we expect you to deploy an API, but we’re not going to tell you exactly how to do it yet, because we don’t think there’s agreement on how to do it—so, you guys go figure it out.’ That kind of iterative process is a good approach.”
For its part, Cerner is committed to implementing FHIR, which is already a part of its product offering, with the emerging standard serving as the basis for the company’s open API, according to McCallie. Nonetheless, he believes mandating FHIR right now would be “putting the cart before the horse.”
Instead, McCallie believes that, over time, as industry “coalesces around the best way to implement” FHIR, then “put certification tests around a particular standard in place.” He adds: “Let us in industry make sure it’s going to work, and then you can turn it into a required standard.”
Micky Tripathi, president/CEO of the Massachusetts eHealth Collaborative and manager of the Argonaut Project, an industry-wide effort to accelerate the development and adoption of FHIR, notes that the Argonaut Project has produced implementation guides that are related to the Common Clinical Data Set.
“If you think about it in terms of cooking, a standard is kind of like the ingredients and an implementation guide is the recipe,” says Tripathi. “When ONC has a standard that they require like for labs, they point it to a particular implementation guide.”
Still, McCallie asserts that “in general, it’s much better to have a market-driven approach to get you the success you’re looking for than to have a regulatory approach—which is slow to change and slow to adapt.” According to McCallie, market forces are “much more nimble and can keep up with changing demands.”
Likewise, Tripathi concludes: “If a standard is well used, then why do you need to declare a standard?”
Steve Posnack, director of the Office of Standards and Technology at ONC, notes that ONC’s Interoperability Standards Advisory already references FHIR for several interoperability needs.
“With respect to certification, ONC is actively observing FHIR’s maturity from a standards perspective as well as its overall use in industry,” says Posnack. “Whether it would ever become part of health IT certification largely depends on several factors. For instance, whether a purpose for which FHIR would be best deployed would benefit from the implementation consistency that testing and certification can help provide. Given the breadth of purposes with which we’re seeing FHIR used, it would be necessary for any future FHIR-specific certification requirements to be aligned with a clear and well-defined use.”
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