The healthcare industry yearns desperately to find the key to interoperability among disparate electronic health record (EHR) systems. Physicians need the capability to exchange health information easily to improve care coordination, which could lead to better patient outcomes and possibly lower costs. But the current methods used to exchange data have fallen short. Health information exchange networks have not spread widely, and a method of secure messaging that uses Internet protocols has not yet caught on with a critical mass of providers. Even when physicians do exchange information, it is usually in the form of PDF care summaries.
A new standards framework called Fast Health Interoperability Resources (FHIR) promises to change all of that by creating plug-ins for EHRs without the need for interfaces. FHIR-based APIs, when they’re fully developed, could allow providers to pull discrete data from EHRs other than their own; could enable consumers to use data from their own electronic records in mobile health apps or store it in personal health records; and could expand the capabilities of EHRs by enabling providers to select apps that provide features not present in their EHRs.
The federal government is optimistic about the promise of open APIs such as the one associated with FHIR. In the regulations for Stage 3 of the government’s EHR incentive program, aka “meaningful use,” physicians are required to allow patients to view, download, or transmit their records either through a Web portal or by using an app plugged into their provider’s EHR. The latest certification requirements for EHRs – which vendors must meet to have their products qualified for meaningful use – specify capabilities that require the use of APIs.
But FHIR is still a work in progress, and it may not be an important factor in interoperability for three to five years, according to Mickey Tripathi, CEO of the Massachusetts eHealth Collaborative and director of the Argonaut Project, a coalition of EHR vendors and others that are testing and implementing FHIR.
One reason for this long development period, he says, is the fragmentation of the healthcare industry, which makes it difficult to orchestrate the adoption of new standards. Second, healthcare is more complex and uses many more different kinds of data than other industries, complicating the implementation of standards. Third, he points out, an ecosystem of business and legal conventions must be created before FHIR-based APIs become widespread.
In the meantime, however, some EHR vendors are racing to build FHIR-enabled products. Both they and outside developers are starting to create plug-in apps. And healthcare providers are getting excited about the potential of FHIR to increase data liquidity and improve the usability of EHRs.
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