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Intermountain Healthcare executive talks FHIR standard

Stan Huff has spent years helping create what he believes is now one of the best standards for moving healthcare closer to interoperability. The Fast Healthcare Interoperability Resources (FHIR) standard, developed by standards organization Health Level 7 International (HL7) for the purpose of exchanging clinical data electronically, saw its fourth release last month. From Huff’s point of view, the FHIR standard takes the healthcare industry to a “new level of interoperability.”

Huff, chief medical informatics officer for Intermountain Healthcare in Utah and co-chairman for an HL7 working group, said FHIR R4 addresses a major pain point for developers.

The most important development in FHIR R4 is that much of its base platform is now normative and backward compatible. The designation indicates a level of maturity and stability and, for developers, promises fewer changes to the base platform’s structure going forward so that programs written against FHIR R4 will work in future versions, Huff said.

Before this, programmers who built applications on an earlier version of the standard were forced to go back and make significant changes to the program to accommodate the release of a new version, according to Huff.

“Now when we go from version four to version five, there should be few if any changes to those resources, so you don’t have to anticipate or expect that you’re going to have that programming burden when the next version of FHIR comes out,” he said.

The FHIR standard still faces its share of hurdles, such as making additional resources normative and standardizing more medical terminology, Huff said. Semantic interoperability is a general sticking point for the healthcare community, and the FHIR standard is no different. For example, a field in the FHIR standard called the “observation resource,” allows programmers to input codes for medical observations such as blood pressure. But, because multiple codes for blood pressure exist, medical professionals risk how effectively systems can talk to each other, he said.

“If you’re not careful, people implementing the standard will choose different codes and then you don’t end up with a high level of interoperability that people expect,” Huff said. “We’re working right now, trying to include clinical societies and others to converge around exactly the way we use that standard and the way we use terminology to get us to a higher level of interoperability.”

Huff said with the new release of the FHIR standard, he’s looking forward to broader implementation, which will only help improve future versions of the standard.

“I think what we need to do is continue to improve FHIR, to use FHIR and add information models and terminology that we need to make it even more interoperable,” he said. “And that’s the path we should be on.”

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