Light My FHIR!!!

I’m sure Jim Morrison is turning over in his grave as I’ve pirated the title of his greatest hit to write this blog!!! The FHIR I’m referring to is a fast emerging technology that if adopted can and will lead to better interoperability in healthcare. Early in my career, I was part of the company that built the Cloverleaf Interface Engine. Cloverleaf is installed in 72% of the hospitals above 100 beds in the US. The goal of the product was to help disparate systems communicate with each other using HL7, which was the standard at that time.

So, if we were very successful selling the product, why is healthcare still so siloed??? Without diving into the weeds, the prurient interests of the major HIT vendors allowed the HL7 standard to be modified to suit their individual product lines. That effectively made the only thing standard about HL7, the name HL7.

The good news is that FHIR is supported by all major EHR vendors in the market and some of them even offer FHIR marketplaces. The bad news is that these marketplaces are rather expensive, and some have rather onerous intellectual property terms. This has caused adoption to be slower across the industry.

That said, FHIR offers a great opportunity for our industry to move beyond the stodgy technology infrastructure we’ve suffered through for all these years. The data models are solid, the FHIR community behind it is incredible, API’s are easier to learn, and FHIR facilitates interoperability with legacy standards. Finally, it describes an easy way to use terminology services, which is a huge issue in healthcare.

There are issues however. A generic informational model is not always the easiest, and fastest way to implement specific use cases. You’ll need to do your homework, and keep the community up to speed with how you’re using the standard. Migration between FHIR versions is painful because there is no backward compatibility. Both the extensions, and profiles can be complicated to use.

FHIR doesn’t address technological concerns such as your system architecture, system-to-system integration, security, and analytics. The FHIR standard API is limited. Anticipate that you will have to extend the FHIR API with additional capabilities and endpoints. FHIR is not a security protocol, nor does it define any security related functionality. FHIR doesn’t address infrastructure. Because of this, we should be looking at platforms that offer cloud infrastructure out of the box.

Nothing in healthcare comes easily. Having been around since the inception of the HL7 standard, FHIR is designed to do great things for healthcare. Whether its adoption reaches it’s full potential depends on overcoming the few limitations we’ve noted. The promise far outweighs the limitations.