We are on FHIR 🔥🔥🔥
TLDR:
FHIR |(Fast Healthcare Interoperability Resources: www.hl7.org/fhir) is a modern standard for healthcare interoperability that promises easier development, modern tooling and expandability. This is making it accessible to nearly anyone.
With the current boom in HealthTech, partially driven by the COVID-19 pandemic, there is an increase in private companies looking to integrate their products and services into healthcare systems, including us folks at Ufonia.
We’re making an autonomous telehealth platform with a mission to scale healthcare. We make calls to patients where Dora, our AI, has clinical conversations.
What do we get out of integration?
An integration usually provides access to the hospital electronic health record (EHR), for our use case, we retrieve patient demographics such as first name, last name and date of birth, lists of patients we need to call (Appointments) and upload reports (DocumentReference) detailing outcomes of our calls.
By integrating with hospitals programmatically we can automate the process of inputting this information into our calls and outputting outcomes back to hospitals.
This allows us to remove more human power from our processes enabling us to offer better pricing, consistency and accuracy.
What is Fast Healthcare Interoperability Resources (FHIR)?
FHIR is an upcoming RESTful Application Programming Interface (API) based standard for healthcare interoperability, giving software engineers a familiar interface before HL7 FHIR a messaging based system was used, HL7v2 which requires deep domain knowledge and looks a bit like this:
Created in 1989 this HL7v2 standard is used globally. Recently the 21st Century Cures Act was passed in the United States requiring FHIR.
In the UK there is still no prescribed interoperability between suppliers or even the Trusts themselves, which has led to a varied range of uptake so far based on factors such as funding and Trust leadership. NHS Digital and NHSx (now both RIP), however, have adopted it for many of their services such as the Patient Demographic Service (PDS).
Ufonia On FHIR
Here at Ufonia, we decided to use FHIR internally within our microservice architecture. This has built internal knowledge of FHIR for those not working directly with it on a day to day basis.
The reality of healthcare interoperability is that there isn’t one solution, with many different standards and more importantly implementations of that standard. This lends itself to having a point that interfaces with many hospital systems and provides a singular interface or even source of truth. A common solution is to build an “Integration Engine” which handles converting structures into a common format.
Our integration service provides an R4 FHIR API, built from converted previous FHIR versions, proxies of R4 and HL7v2 messaging.
We have offerings ranging from demographic lookup to automatic clinic importing. We are actively targeting FHIR sites and currently live at two in the UK, as they give us a faster turnaround time on integration.
As an early stage company, FHIR has given us the ability to provide integration in other territories such as the United States, reusing our existing code base and experience.
Pros:
- Easy Adoption: we already use RESTful APIs throughout our product, reducing our learning curve
- Easier future integrations into the other markets.
- Human readable resources
- Faster integration turnaround
- NHS X and NHS Digital Recommended
Cons:
- Currently extra costs for Trusts and suppliers to turn on FHIR integration in their EHRs
- Localisation not yet supported by EHRs (UK Core)
- Non-compliance of implementers to FHIR specification
- Limited support for all features of the specification
Spreading FHIR…
FHIR is a great step forward in modernising interoperability in healthcare, though in it’s early stages, it already shows great promise.
