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Experts say there's still a long road ahead for the FHIR standard

Panelists at ONC's 3rd Interoperability Forum in Washington, D.C., talked about the FHIR standard lacking maturity, as well as facing implementation challenges.

A major issue hindering interoperability in healthcare is a lack of data standardization, something federal regulators are trying to change by pushing adoption of the Fast Healthcare Interoperability Resources standard.

FHIR is an interoperability standard developed by Health Level Seven International (HL7) for the electronic exchange of health data. The FHIR standard has gone through multiple iterations and taken five years to develop. It sets a consistent description for healthcare data formats and application programming interfaces that healthcare organizations can use to exchange electronic health records.

In a set of proposed rules for interoperability from the Office of the National Coordinator (ONC) for Health IT and the Centers for Medicare and Medicaid Services (CMS), the agencies would require healthcare organizations to use FHIR-enabled healthcare APIs that would allow patients to download their standardized electronic health information into a healthcare app on their smartphones.

During a panel discussion on the future of interoperability at ONC's 3rd Interoperability Forum in Washington, D.C., Thursday, panelists including Kisha Hawthorne, CIO of Children's Hospital of Philadelphia, focused on the reality of using the FHIR standard, and whether the standard will help achieve interoperability in healthcare.

The reality of FHIR standard use today

Will the FHIR standard be a key facilitator of interoperability in healthcare? Panelists agreed that it will -- in time. Right now, though, the standard still needs work in the implementation department.

In the provider space there's a ways to go. But we're excited and we think it will take hold.
Kisha HawthorneCIO, Children's Hospital of Philadelphia

Hawthorne said her team at Children's Hospital of Philadelphia is looking to use the FHIR standard in the provider space to bridge the gaps between the different software vendors with which the organization works.

The hospital uses an Epic EHR, and Hawthorne said that while she thinks vendors like Epic are beginning to implement and use the FHIR standard, she hopes to see that work "fast forward" with Epic and other vendors to make it easier to gather and share, as well as use, data in the provider space. FHIR standard use is something that's not quite there yet, she said.

"In the provider space, there's a ways to go," Hawthorne said. "But we're excited and we think it will take hold."

The potential of the FHIR standard is exciting and it will "open a lot of doors," but the reality is that the standard is immature, said Kristen Valdes, CEO of personal health app b.well Connected Health.

Valdes said that although she thinks the FHIR standard will create a push toward interoperability in healthcare, challenges associated with implementation of the FHIR standard are hindering progress.

A significant number of providers and organizations aren't "using a fraction" of the implementation guidelines that have been made available for the FHIR standard, she said. While organizations are thinking about the operational impacts of using FHIR on behalf of users, she said there continues to be ongoing debate about the proper HIPAA rules to provide consumers access to their own data, which also hinder its implementation.

"We really have to think about the operational workflows and how it's going to affect the people who are expected to implement and deploy FHIR," she said.

The problem with the FHIR standard isn't the technical aspects of the standard, but the process and people implementing it, said Vik Kheterpal, principal of interoperability product vendor CareEvolution.

As a technology standard, Kheterpal said it makes sense and has already seen relative success in the launch of programs such as CMS' Blue Button 2.0 program. Blue Button 2.0 uses the FHIR standard for beneficiary data, such as drug prescriptions, primary care cost and treatment. Yet, the problem with the rest of healthcare often lies in misinterpretation of policy when it comes to sharing patient data.

Anil Jain, chief health informatics officer at IBM Watson Health, said he thinks the value of the FHIR standard is real, and organizations already need to think about what's next once the standard matures.

As use of the FHIR standard grows among healthcare organizations, Jain said it's important to create businesses cases and models for sharing data that will work using the standard. Otherwise, providers and patients will continue to lack trust in the data, something a standard like FHIR alone won't give healthcare.

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