The Fast Healthcare Interoperability Resources (FHIR) is healthcare-specific standards framework that in theory solves the problem of EHR-to-EHR interoperability, but experts say there is a long way before FHIR is widely adopted.
The whole purpose of digital healthcare was to provide everyone access to their Electronic Health Records (EHRs). While the industry is starting to achieve some degree of interoperability among the EHRs, many data is still locked up in documents. This limits the ability of healthcare providers to get access to discrete data from outside sources keeping the care limited.
Interoperability among the computer systems in healthcare is difficult because the industry is exceptionally fragmented. Hospitals, nursing homes doctors, and even emergency care centers, all use many different types of EHRs. Even health insurers use a range of other systems. All the interfaces are quite expensive to build and also challenging to maintain.
Over complicating this scenario are the business reasons where some EHR vendors as well as provider enterprises create barriers to electronic health data exchange. The federal Office of the National Coordinator of Health IT (ONC), has proposed a rule that prohibits such ‘information blocking,’ and this FHIR standard could enable interoperability among EHRs.
Experts suggest making the exchange of discrete data easier by ensuring health centers and physicians have government-certified EHRs that include APIs based on the emerging FHIR healthcare-specific standard. FHIR standards framework uses the same kind of APIs that underlie most of internet commerce. FHIR-based applications can be plugged into any EHR that is FHIR-capable without a customized interface.
Though the solution sounds quite easy, CIOs believe that there is still a long way before FHIR is adopted widely for EHR-to-EHR interoperability. But currently, FHIR-based apps are used to expand the functionality of EHR that enable patients to download their records. While over 25% of hospitals have systems that are capable of semantic interoperability, the industry needs a lot more than that.
Among the profiled resources, it is almost 80% of the information that doctors require, but profiles are quite a small percentage of the data in a particular EHR. There is a vast amount of unstructured text that forms the majority of the content. There is also a big chunk of the structured data that has not been coded to allow semantic interoperability. This is a significant problem for FHIR APIs to create interoperability.
Experts stress on the need for resources to be created and profiled to cover more of the content of EHRs to be FHIR friendly and can be used like ‘plug-and-play’ with each other. Currently, there are some FHIR-based apps, but they too have limitations where only read-only access to EHRs is available. Experts have also noted that FHIR integration is mostly outbound, and discrete data inbound via FHIR isn’t occurring.
Quick adoption of the FHIR-based interoperability is also something that is not happening anytime soon, since healthcare organizations are not open to changing their current methods of information exchange.
Evaluating the use of FHIR-based applications, experts also mention the security and privacy concerns that come with it. Currently, healthcare organizations are authenticating patients on their portals, while EHR vendors are registering apps that are developed by third-party vendors. There is a need for stricter regulations to safeguarded patient records after they move the health data to third-party apps.
Among all the issues, experts are very optimistic about the future of interoperability, and that requiring FHIR-based APIs in EHRs will be a big step forward. Comparing this to the financial services industry that took 25 years to get ATMs to talk to one another, experts believe that considering the complicated space of healthcare, the industry has made good progress.