Classic HL7 interfaces are being augmented by APIs and HL7 FHIR: Are you ready?
APIs are nothing new, yet they account for a majority of the Internet’s sharing of data between applications, powering sites such as Twitter, Amazon, and Facebook. APIs are particularly useful for social sites because they allow just the right amount of data to be exchanged.
As discussed in greater detail in The Untapped Potential of Health Care APIs, published in the Harvard Business Review, provider usage can be broken down into two categories:
- Open API for patient data sharing
- APIs for traditional provider integration strategy
With the promise of rapid, lightweight, standardized integration with HL7 FHIR, there are many real world use cases an API can enable — think population health databases with real-time data and analytics, granting patients’ access to their medical records via smartphone, and medical research opportunities that arise from access to key data.
Dave Shaver, instructor of the Corepoint Health webinar and co-chair of the HL7 FHIR Governance Committee responsible for FHIR’s strategic direction, answered the follow questions about how the industry is poised to make major strides in interoperability.
How is data exchange different using web APIs and FHIR compared to traditional HL7 interfaces?
“The interoperability standards we have today are focused on exchanging transactions at certain points of the care lifecycle. In HL7 version 2 that’s focused on patient care, including myriad activities such as administrative tasks, admission, discharge, orders, or results availability. Clinical administrative data is being moved at a certain point in time during the lifecycle of the data. This means it’s difficult to ask questions about that data, except when it has reached that exact point in its life cycle.
FHIR, on the other hand, is envisioned to be more of a capability-based API that allows a vendor who is storing clinical data to grant access to the data through simple web service queries. For the first time we’re going to have a standard in FHIR that will allow applications to query the source of truth for data when they need it, not just when it reaches a specific point in its lifecycle.
HL7 v2 and CDA documents rely on a push-model of data exchange. FHIR, on the other hand, is more of a pull-model.”
What do CIOs need to know about the future of data exchange?
“FHIR has the potential to create significant change in the healthcare infrastructure over time.
The ability of a vendor like Cerner or Epic or Allscripts or MEDITECH to publish a capabilities-based API, which allows the hospital’s technical team, clinical team, or workflow team to orchestrate a custom solution, is a green-field opportunity that healthcare has never had before.
Normally we have to orchestrate those workflow solutions within the context of the given application. Depending on the EHR vendor’s flexibility, the fact that FHIR APIs will allow access to data and the source of truth is really exciting.
Wes Rishel, one of the founders of HL7, likes to say, ‘When you’ve seen one HL7 interface, you’ve seen one.’ That’s reasonably true because no two hospitals or two clinics are alike. Which means that when you’ve seen one customized installation of Cerner, you’ve seen a unique installation of Cerner unlike anything anywhere else. The customization of today’s EHR software to meet users’ unique needs means that the interfaces become very custom as well.
FHIR is different. From the very beginning we have built the idea of conformance and the ability to test that conformance. So when the vendor claims that they support FHIR, a CIO can ask to see the conformance profiles and ask them where they are published. Having access to that information will tell the CIO exactly how the vendor is able to use the FHIR standard.”
How far off are we from seeing FHIR APIs?
“For several years, many individuals and vendors have been testing and using the early versions of FHIR. Today, all the major health IT vendors are currently participating in the creation of APIs using FHIR, which is fantastic to see. The Argonaut Project is by far the furthest along in this aspect.
The normative edition of FHIR (Release 4) will likely be published toward the end of 2018.
Users can’t take advantage of FHIR until it’s available for use in the applications – and only when those new versions of the software are actually installed at the hospital.
Without a doubt, we are moving faster as an industry to implement FHIR than I’ve ever seen before, and I’ve been doing nothing but healthcare integration since 1993.”
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