How FHIR is poised to change healthcare IT landscape.

Feb 24, 2018 · 4 min read

Since the inception of FHIR, there is lot of speculation and attention around it. Based on my HIT development and management experience, I am going to take a deep dive in this article to discuss how FHIR is going to change healthcare landscape. In my previous article, I discussed about the importance of FHIR. FHIR brings new data format to life that is going to reduce the complexity of healthcare information exchange. We call FHIR as a open source technology in healthcare space.

Based on MU3 requirement, EMR vendors like Cerner and Epic have opened up their EMR system with FHIR APIs. MU3 requirement primarily focuses on giving patient an ability to access their patient data from any EMR system using an app of their choice such as Health Records app from Apple. Even though regulatory requirement is limited to patient access of EMR data, EMR vendors collaborated in the right direction by extending FHIR APIs for provider space. What that means is application developers can develop apps not just for healthcare consumers but also for providers (Physicians, Hospitals, Clinics).

Today implementing an healthcare app by integrating with existing clinical systems is an expensive and resource intensive project due to fragmented healthcare system and complex data exchange technologies. Also, developing an healthcare application requires strong skill set of combination of proprietary healthcare technologies such as CCL, Cache, HL7 and many more. These are not close to open source technologies such as Restful with JSON so that any skilled developer or startup with a cool healthcare app idea can hit the ground with little effort. These technologies have a huge learning curve and no or little development documentation available on public network so it is difficult for one to master healthcare technologies without direct experience in healthcare space.

With FHIR APIs, this is going to change at least in the patient space. Provider space would still require experience in healthcare space to understand clinical workflows. But it is going to reduce dependency on expensive and EMR proprietary technologies. Let me discuss few use cases to make it easy to understand the FHIR API utilization.

Developers or consumers can develop apps to read data from personal health devices like Fitbit, Gluco Meters, Cardio monitors and upload / integrate that data with EMR system by calling FHIR APIs. Another example would be consumers can integrate pre-natal, pregnancy, post -pregnancy such as baby feeding data into EMR system seamlessly. Alright, we have integrated daily health data from IOT with EMR and that saves time for patients and providers from collecting data for next visit. With single click, providers can review that information inside the EMR.

Is there any other advantage to it besides aggregating data. Yes, Developers can develop apps that process this information in the background and create clinical decision support notifications for providers. For example, based on above data CDS app detects that a baby is not receiving enough milk or food and sends a notification to provider to review the data and reach out to mother if needed. These intelligent CDS notifications would save time for clinicians by automating the data processing. Another example would be CDS app sends notification to provider if consumer’s cardiac data is not consistent with expectation of prescribed medication or care plan so that clinician would followup with consumer if needed regarding medication adherence to prevent readmission or complication. We reviewed two real time use cases covering workflows for both patient and provider space and how it helps managing community health with the help of automated processes that would cut down EMR overhead for clinicians with data from billions of IOT devices and improve outcomes which is crucial for value based healthcare reimbursement. And, this is going to personalize the healthcare delivery.

One thing I did not introduce but mentioned in the above paragraph is CDS service. CDS service another cool technology that built on top of FHIR technology, which is going to open EMR system to utilize external Clinical Decision Support service. You can learn more about CDS hooks here. I am going to jump into next section of how FHIR technology is going to transform fragmented healthcare space for good reason.

As I mentioned in my previous article, with FHIR APIs, EMR vendors opening up their EMR system as a healthcare app platform similar to Android and iOS as platforms for mobile apps. Today, healthcare organizations using applications form different vendors to meet their unique needs, are relying on complex data exchange processes to integrate the data between different systems. Implementing new applications is becoming a challenge due to these complex data integration processes. With SMART on FHIR, these applications are going to co-exist inside the EMR ecosystem. SMART is another technology built on top of FHIR to allow external apps to integrate with EMR or co-exist inside EMR. You can learn more about SMART here. This is going to make clinical workflows integrate seamlessly and reduce IT overhead for clinicians. SAMRT on FHIR with CDS hooks have a capability to auto launch apps based on clinical workflow. It creates one stop shop for clinicians to access different systems and data with no effort. It would be an ideal state for clinicians to access HIT systems and data on one platform.

Altogether, SMART on FHIR with integration of CDS hooks is going to open doors for developers and startups that drive development of new apps that integrate or co-exist with EMR system seamlessly.

To learn more about latest HIT technologies please refer to this article.

To learn about FHIR challenges please refer to this article.

About author: Author has more than 10 years of HIT development and management experience on HIT cutting edge technologies. Author is a co-founder of MDguna platform.


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MDguna is an innovative population health analytics platform utilizes big data and machine learning technologies to pioneer healthcare IT products.

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