FHIR uses snippets of data known as “resources” to represent clinical domains within EHRs, such as diagnoses and medications, and other clinical entities. These resources can be built on top of standardized data types and are utilized in a Restful API similar to those that app developers already use across the Internet. The Argonaut Project is using another common Internet standard, OAuth, to enable patients and providers to authorize the use of their healthcare data.
Health Level 7 (HL7), the leading standards development organization in health care, has recognized FHIR as a draft standard and has identified 99 FHIR resources. To specify these resources, HL7’s members will have to create profiles for each of them — a long and arduous process. The Argonaut Project decided early on to focus on profiles for 16 resources that represent the common data set used in HL7’s Consolidated Clinical Data Architecture (CCDA).
Argonaut made this decision, Tripathi says, partly because the meaningful use program requires providers to exchange care summaries in the CCDA format. The other reason, he notes, is that 20 FHIR resources cover about 90 percent of everything that happens in health care. These resources are a “close fit” with the meaningful use common data set.
To date, Argonaut’s members have tested profiles for 12 resources, as well as OAuth, and will soon test several more profiles, Tripathi says. Epic and Cerner, two major EHR vendors that belong to Argonaut, are already experimenting with FHIR-based apps. Within a year, he predicts, several EHR companies may start selling such apps to their customers.
SMART on FHIR
FHIR alone cannot give developers all the components they need to write apps for EHRs. It can translate clinical data into objects that apps can use, but an app developer also needs to know the restraints on vocabularies and how the data will be coded, points out Joshua Mandel, M.D., a research scientist in Harvard Medical School’s Department of Biomedical Informatics and a research faculty member at Boston Children’s Hospital. To provide these missing pieces and a graphical user interface, FHIR is being used with an open, standards-based platform known as Substitutable Medical Applications and Reusable Technology (SMART).
“SMART helps to lock down those vocabularies or data profiles,” Mandel explains. “We also provide a security layer that allows a user to approve an app and to launch it within their EHR. We provide some user interface glue so that the app can learn what’s happening around it in the EHR system: for example, what patient is currently being sought in the EHR. We try to provide the whole stack of tools that a developer would need to build a plug-in app.”
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