A Dose of Reality in Healthcare IT Interoperability: Is FHIR the Answer?

12.11.17 By Gabe Rivero



US healthcare, for many years, has been a highly complex enterprise with a “cottage-industry” structure consisting of many small-scale, interdependent service providers. We’re seeing the dichotomy of large payment practices clashing with a personal treatment structure, creating silos of function and enterprise. 


While IT was supposed to improve efficacy, we find that primary care physicians are spending over 50% of their workdays clicking around EHRs (not to mention the 1.4 additional hours spent on EHRs outside the work day). Many feel that they are neglecting patients, and physician burnout is at an all-time high.


Wasn’t healthcare technology supposed to increase productivity? Maybe it’s time to revert to paper, and those massive wall-like drawers that stored patient files.


Technology on its own will not improve operations. Utilization is where efficiencies lie. As healthcare IT conversations center around resourcefulness, the systems in place are overly complex.


Rushed implementations result in forcing a solution that:

  • Does not “speak” to other systems - so any potential data exchange becomes manual
  • Is not tailored to your organization – so you have to buy the full system even though you plan to only use half of it
  • Skips crucial steps like training – so when you’re finally up and running, adoption becomes more challenging


This discussion has largely taken place on a macro level, as if technology will swoop down and save the industry. The technology, itself, can only do so much. Individual processes and how practitioners use their tools is an immediate step any hospital system can take to improve care.


Tools like FHIR and ServiceNow are a step in the right direction to improve interoperability, but as important to the tools are the processes and people using them.



Like It or Not, the Future Is Set on FHIR


Thought I'd throw in another FHIR pun, just in case you weren't completely sick of them.


A Brief History

In 2011, HL7, a non-profit healthcare exchange organization, decided to take a fresh look at how applications and EHRs exchanged information. Speed and adoption were key, and they found that using a web approach would provide the simplest implementation.


They developed FHIR, which remains the darling of healthcare IT conversations due to its value of potentially opening information exchange.


FHIR seeks to provide implementers with a specification that is simple to understand, quick to adopt, easy to troubleshoot and yet provides the flexibility to accommodate local needs. Data can be exchanged between systems using RESTful APIs, which group a collection of resources into a bundle. “Resources” refers to a set of modular components. Each resource can be represented using XML or JSON, and store patient information such as medicine allergies, their care plan, and history.


Given its simplicity, code and example servers already exist, and specification is free for use with no restrictions. It’s web-based, but can be extended and adapted for local usage.


Early Adoption

There is still an uphill climb to reach the much sought after “standard” label, but FHIR has a few things going for it that should expedite its ascension.

  • Cerner Corporation, Epic Systems, the Mayo Clinic, and just about every other EHR have adopted FHIR even though it’s still in beta. The demand and community interest will accelerate FHIR as user input increases and new utilization methods, such as point of care real-time data access.
  • FHIR utilizes URLs as identifiers for data, making data labeling and exchange both uniform and unique. Other attempts at interoperability use a document-focused approach, which adds complexity to information exchange.


FHIR looks to become the mainstay that will solve the data exchange issues, but what about operations and resourcefulness?



Data Exchange Is Only Half of the Equation

The other half involves utilization - which can be a trap if you're not prepared. While FHIR is making it easier to access data, and is system-agnostic, those systems still need to be implemented to fit the needs of your organization.


We covered this extensively with the 5-part blog on implementing ServiceNow. The most notable sign of a failed implementation is lack of adoption, when people do not want to use the new technology, or worse, cannot use it because they never learned. You’ll also find unforeseen complexities, delays, and a lack of healthcare operational expertise by vendors.


The bottom line is that, while the technology can lower the costs of healthcare and improve operational efficiency, it needs to be used correctly, or the benefits are negated.


The difference between a vendor with healthcare process experience, and one without, is stark – as depicted in this example when one of the most recognized children’s research hospitals in the US replaced an underperforming vendor.


To answer the question of whether there is progress in interoperability. Yes, FHIR will take on an increasing role in data access, but the people implementing the technology and users will determine its efficacy.


4th Source has experienced FHIR experts on hand, who can help your team keep up with integration and adoption as the platform continues to progress. Download our latest resource, Maximizing IT Resource Potential in Healthcare here.