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Can We Light a Fire on Healthcare Interoperability with FHIR?

A new group thinks so.

Health Level Seven International (HL7), five EHR vendors, and four provider organizations have launched the Argonaut Project. This project is designed to provide acceleration funding and support political will to publish FHIR implementation guides and profiles for query/response interoperability and document retrieval by May 2015. The mission is to advance the adoption of the FHIR standard for improving the electronic exchange of patient data among providers and to drive healthcare interoperability. It will focus on HL7’s FHIR and also work to advance an API standard to improve clinical information exchange and interoperability for EHRs and other health IT entities.

The group consists of:

  • athenahealth
  • Beth Israel Deaconess Medical Center
  • Cerner
  • Epic Systems
  • Intermountain Healthcare
  • Mayo Clinic
  • McKesson
  • MEDITECH and
  • Partners HealthCare
  • SMART at the Boston Children’s Hospital Informatics Program
  • The Advisory Board Company

So what is FHIR and why coalesce around it to advance healthcare interoperability?

FHIR, the Fast Healthcare Interoperability Resources specification is a new standard for exchanging healthcare information electronically.

FHIR defines a set of “resources” that represent granular clinical concepts. The resources can be managed in isolation, or aggregated into complex documents. This flexibility offers coherent solutions for a range of interoperability problems. The simple, direct definitions of the resources are based on thorough requirements gathering, formal analysis, and extensive cross-mapping to other relevant standards. Technically, FHIR is designed for the web; the resources are based on simple XML, with an http-based RESTful protocol where each resource has predictable URL.

“FHIR is the “HTML” of healthcare. It’s based on clinical modeling by experts but does not require implementers to understand those details. Historically healthcare standard were easy for designers and hard for implementers. FHIR has focused on ease of implementation.”John Halamka ‒ HIT Standards Committee Co-Chair and CIO at Harvard and Beth Israel Deaconess Medical Center

While affirming that HL7’s FHIR is interoperability’s future, Halamka emphasizes that “We are not creating a new organization to do this work; instead we are all unifying around HL7 as an ANSI-accredited standards development organization to deliver what we all need.”

So what makes FHIR different for healthcare interoperability?

FHIR appears to offer more tangible benefits than past newer standards such as HL7 3.x. FHIR does not impose the rigid workflow of traditional HL7 which has hindered its progress and adoption. Additional benefits of FHIR as summarized by the HL7 standards organization are:

  • A strong focus on implementation – fast and easy to implement
  • Specification is free for use with no restrictions
  • Interoperability out-of-the-box – base resources can be used as is, but can also be adapted for local requirements
  • Evolutionary development path from HL7 Version 2 and CDA
  • Strong foundation in Web standards– XML, JSON, HTTP, Atom, OAuth, etc.
  • Support for RESTful architectures.

The straightforward RESTful style approach that FHIR uses offers loose coupling. Clients therefore do not need to be aware of internal implementation details and there is the benefit of platform and language independence. It also allows for extreme scalability, all good things when it comes to integrating systems.

With its characteristic focus on pragmatism, FHIR also follows the 80/20 rule that will focus on 80% of the common use cases rather than the 20% of exceptions and provide more general value. It has been designed to satisfy the needs covered by all of the previous primary HL7 interoperability standards (V2, V3 and CDA), hence the reference in the summary benefits to an evolutionary development path. By allowing this coexistence, the standard allows time for users to migrate and adopt the new standard while still supporting the legacy HL7 standards.

However, in discussions and reports on FHIR at Joint HIT Policy and Standards Committee sessions in 2014 and elsewhere, the point is raised that while FHIR is a major step forward, why should we have reason to believe that we won’t go through the same cycle of early hype until FHIR is tested in interoperability across vendors or implementations? The Argonaut Project is exactly an effort to accelerate seeing true benefit and deal with the real challenges of identity management, information governance, adaptations in workflow, and business agreements.

By leveraging experience with past standards, FHIR hopefully will provide ease of interoperability that will gain broader healthcare interoperability support. FHIR may eventually replace some or all of these previous standards. Most likely, and practically speaking, existing standards and FHIR will be utilized in parallel for quite some time.

PilotFish is joining the ranks of other leading vendors with a commitment to support FHIR. Until the time where FHIR becomes the predominant standard users of PilotFish’s healthcare integration engine can continue to work with older or legacy technologies knowing that they will be able to just “turn the switch” when FHIR does catch fire.

For information on how PilotFish can help your organization solve its integration challenges please contact us at 860 632 9900, ext 309.

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Monika Vainius

Written by: Monika Vainius

Executive Vice President of Applied PilotFish Healthcare Integration. Monika has extensive experience with systems interoperability. She combines this experience with her professional passion for healthcare and healthcare technology to comment on current healthcare and IT news. Website

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