Jeff Rowe, Editor, Future Care

Jeff Rowe is the editor of Future Care and a veteran healthcare journalist and blogger who has reported extensively on initiatives to improve the healthcare system at the local, regional and national level.

FHIR helps providers build bridges to improve data access

March 17, 2017 AT 3:32 PM

We live in a hybrid environment, which requires each of us to know how to navigate myriad languages and forms of communication.

However much that contention might apply to the culture at large, for our purposes here it captures the primary takeaway from a conversation our colleague Mike Miliard recently had with  Russell Leftwich, MD, senior clinical advisor of interoperability at InterSystems and and an HL7 board member, as well as co-chair of both HL7's Learning Health Systems Workgroup and its Clinical Interoperability Council, over at HealthcareIT News.

The two sat down at HIMSS17 in Orlando, recently, to discuss the status of HL7’s FHIR (Fast Healthcare Interoperability Resources) specification and what it promises for the future of healthcare. As Leftwich sees it, moving forward FHIR will increasingly be the preferred technology for new development because “the reality of today is that there's data across many systems, for an individual or a population,” and FHIR will enable users to access and understand data stored in an array of systems and formats.

And, as most stakeholders understand on a daily basis, that “array” is broad. According to Leftwich, “the average hospital today has in excess of 80 systems within their walls,” and “for the foreseeable future, there is no compelling economic argument to replace the uncounted billions of dollars worth of existing systems that use existing standards and do what they do perfectly well with them.”

At the same time, providers and other stakeholders are increasingly bent on sharing information across cyber-walls, which brings us to FHIR.  According to Leftwich, “FHIR will serve as a translation layer, as is the case with InterSystems' informatics platform, which has now become enabled so data can come in in existing standards like V2 or CDA documents, and can be transformed into FHIR and take advantage of the technology FHIR is based on to do things with that data. And then can be exported from that platform as any one of those standards, including FHIR, back to systems that may only understand some of the existing standards.”

FHIR’s advantage, Leftwich contends, is its adaptability. “It's a new reality of maturity where standards evolve,” he says, “and you use the current version because it's useful and the F in FHIR stands for fast, and it is fast to develop applications with FHIR, and implement them, and they operate in this technology world that the older standards can't take advantage of.”

Interestingly, given FHIR’s primary function as a “bridge” between standards, Leftwich says some of the most exciting aspects of FHIR are when it's used in areas where there are no standards. 

Take genomics, for example. “There's no older genomics standard because genomics hasn't been around that long,” Leftwich says.  As a result, “that was an ideal place for FHIR to become the standard from the beginning. And truthfully it's the only standard that could meet the needs of that domain, because when someone has their whole genome sequenced it creates terabytes of data, and you're not going to be able to move that data around easily. You need to be able to access it, get the important pieces of that data – genomic variant or the tumor mutation – that's reflected in that huge amount of data, and that's what FHIR is ideal for doing.”

For those who want to tap into the benefits of FHIR, Leftwich says it’s important to have a strategy.

“Connecting across an array of systems with some sort of FHIR translation interface probably isn't practical,” he cautions. “Having a platform that can connect to those systems, or maybe is already connected to those systems and can take in data in different formats and standards and transform it into FHIR is, I think, the only workable strategy.”