Patient – Physician Collaboration on FHIR (Fast Healthcare Interoperability Resources)

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The author makes the case that since most organizations have overcome the hurdle of EHR adoption, the next major challenge will be interoperability. He outlines the incentives that are pushing organizations to interoperate, and discusses the use of FHIR to achieve it.

Background

The HITECH Act of 2009 and Meaningful Use have provided financial incentives to providers to implement electronic health record software in their practices; since those incentives became available EHR adoption has increased hugely in the US healthcare system. The author notes that a requirement of Meaningful Use stage 1 is that "more than 50 percent of patients seen by a provider in each reporting period have prompt access to an electronic clinical summary"[1]. Stage 2 does and stage 3 will increase these requirements such that the functionality is required to be used by a certain proportion of patients, including requirements to include patient-generated data. Meeting the meaningful use goals will require interoperability, "the ability to meaningfully share data among these systems and to collect and share data with new devices, sensors, apps and tools increasingly available to patients"[1].

FHIR (Fast Healthcare Interoperability Resources)

The paper briefly notes that HL7 standards have become cumbersome in their complexity; web services have the potential to be much simpler while providing much flexibility. FHIR has emerged from a "simplified data model"[1] derived from "HL7’s extremely detailed Reference Implementation Model or RIM". The author of this framework transferred the rights to HL7[2] and it "is apparently on track to become the US standard" for healthcare interchange under Meaningful Use stage 3[1]. The framework uses a RESTful API to make data available via web services.

FHIR Adoption

The major EHR companies are developing support for FHIR functionality, which in some cases will replace Consolidated Clinical Document Architecture (CCDA).

FHIR as a Collaboration Platform

The author notes that though EHR software is traditionally neither designed nor built for collaboration, FHIR can be used to implement extensions to EHRs to allow for both additional collaboration as well as new CDS features by facilitating the reorganization of existing data.

Discussion

Although "FHIR is currently physician focused", it is "fully compatible with the web"[1], which means that web apps could easily be used to give patients access to their data and to upload their own data, such as from sensors like heart monitors or even activity trackers.

  1. 1.0 1.1 1.2 1.3 1.4 Braunstein, M. (2015). Patient – Physician collaboration on FHIR (Fast Healthcare Interoperability Resources). 2015 International Conference on Collaboration Technologies and Systems (CTS), 501-503. doi:10.1109/CTS.2015.7210457 Retrieved 2015-10-07 from http://ieeexplore.ieee.org/stamp/stamp.jsp?tp=&arnumber=7210457
  2. Five Things to know About HL7 FHIR. Brull, R. 26 March 2013. http://hl7standards.com/blog/2013/03/26/hl7-fhir/