It has been well over a year since we published our HL7 FHIR Primer, which has been downloaded an astonishing 675 times and counting. That primer lays out the basics of how the new health data standards will be used, including key diagrams and use cases such as mobile application access to hospitals’ EHR systems.
While FHIR is still under development by HL7, the second draft standard for trial use (DSTU) became available last year, and the first normative edition is planned for 2017. A few notable developments have occurred regarding FHIR since the primer was published, which provides a great opportunity for a refresh of the document.
Some of the notable advances of FHIR over the past year include:
SMART on FHIR
The FHIR standard can be used for a variety of workflows; however, the key step in enabling the FHIR technology is to have major vendors open up their clinical data in a FHIR repository so other applications can leverage it to solve creative workflow problems.
In addition to having the data available, there is an emerging technology that would take this even one step further. The technology is called SMART on FHIR, and it allows more robust functionality and creative usage of the data directly within the EHR itself. SMART on FHIR would embed third-party functionality directly within the EHR application itself.
In a nutshell, SMART on FHIR enables third party plug-in apps to run natively inside any compliant EHR.
The SMART project started in 2010 with a four-year, $15 million grant from the ONC. The idea was to build an app platform for healthcare allowing support apps to be chosen by clinicians. At the HIMSS15 Interoperability Showcase, several vendors demonstrated the progress they are making by incorporating SMART on FHIR. All the apps use the same underlying set of platform specifications.
The SMART on FHIR specs provide means for health care organizations or developers to access discrete clinical data — such as medications, problems, lab results, immunizations and patient demographics.
SMART on FHIR opens up innovation in healthcare that has not been possible previously. If someone has a bright idea and creates a SMART on FHIR app, the healthcare provider doesn’t need to wait for an EHR vendor to adopt the idea. Assuming they have a SMART on FHIR-compliant EHR, they can immediately take advantage of the bright idea through the use of the app.
The Argonaut Project
Argonaut is a supporting movement of FHIR in the U.S. led by volunteers. Individuals within HL7 were focused on keeping the FHIR project on target with its self-proclaimed deadlines for adoption. This focus was especially important considering the Open API requirements for Meaningful Use Stage 3.
Several the major EHR vendor organizations also wanted to do what they could to help push development and adoption in the U.S. So HL7, along with these vendor organizations, set out to do two things through the Argonaut Project: First, they funded the work to build a U.S.-specific profile. Second, they combine resources to help market and drive adoption of the standard.
The organizations are working with HL7 and the ONC to shed light on the best way to use FHIR in the U.S. considering there are some parts of FHIR that are very international in perspective.
For instance, because there is no consistency around the world with how medication is encoded, FHIR doesn’t make any rules about how medication is encoded. But in the context of the U.S., RxNorm is the coding system used for medication. HL7 is working through many similar types of issues with the Argonaut members. This will hopefully help drive a cleaner, more consistent standard for the U.S., along with a speedier adoption due to the buy-in of the larger vendor organizations that are participating.
Where does FHIR go from here?
The industry is waiting to embrace a standard that offers something better, but given the embedded nature of HL7 V2, the transition will not happen overnight. FHIR tries to fill the gaps that exist with the standards in use today, as was discussed in the full HL7 FHIR Primer.
While the healthcare marketplace will decide whether FHIR survives, coexists, or replaces other products, the modern technologies that it is based on (RESTful, JSON) have already won over other industries.
Additionally, other standards organizations are jumping on board to support HL7 in the development of FHIR. One of those is IHE International, which plans to leverage FHIR across several profiles including: MHD (mobile XDS), PIX/PDQ (patient identification), and PCC (medical devices).
I encourage you to download the full FHIR document, which includes the basics of health data exchange using FHIR, along with the new developments listed in this blog post.
Stay tuned to for many exciting developments around FHIR as it continues to be utilized by many major EHR vendors and, of course, leading interoperability software vendors such as Corepoint Health.