Fri, 06/01/2018

Earlier this year, tech behemoth Apple announced it is launching a personal health record (PHR) feature with iOS 11.3. “App”tly named Health Records, the feature will aggregate existing patient-generated data in the Health app with data from a user's electronic medical record at a participating hospital. At launch, Apple is working with 12 hospitals across the country, including Penn Medicine, Cedars-Sinai in Los Angeles, Johns Hopkins, and Geisinger Health System.

The feature will use HL7's FHIR (Fast Healthcare Interoperability Resources) specification. Users will be able to see things like allergies, medications, conditions, immunizations and lab results, as well as the sort of things that can be usually pulled in a patient chart in an EMR. They can be notified when the hospital updates their data. The data will be encrypted and users will need to enter a password to view it.

What is FHIR?

The Fast Healthcare Interoperability Resource is an interoperability standard that has emerged from the non-profit HL7 organization, and functions as a universal adaptor, allowing some types of clinically relevant data types to be shared easily and securely. FHIR was created with the complexity of healthcare data in mind, and takes a modern, internet-based approach to connecting different discrete elements.  But despite its tremendous popularity, FHIR alone cannot address the core data challenges emanating from different representations of a clinical fact from one EMR to another.

Can FHIR alone solve the interoperability challenges?

No, because data isn’t the same on two sides of the wall. A health system at Vanderbilt may have a completely different architecture than one at Kaiser. The data stored could be so disjointed and all over the place that one system may not even store data in a way that can talk to another system. Data matching issues are further complicated by lack of a national patient identifier.

To understand the challenges in data sharing between healthcare systems, let’s take the example of airfare search sites that don’t generate data on their own. Travel websites like Kayak or Priceline use APIs provided by the individual airlines to pull information into a single view for the end consumer. Applications built on FHIR specifications such as those built using SMART on FHIR in many ways can accomplish that goal given the underlying data to represent the FHIR resources are in a standard industry format. Imagine three different airlines responding to airfare and schedule information in three different currency notations and languages. Would it not be a nightmare for consumers if each search result they had to convert the airfare to their local currency or use a language translator to understand the detailed flight schedule?

Interoperability is no longer a nice-to-have showpiece

Efforts such as FHIR are important because they start to simplify our industry’s interoperability problems, and that’s crucial. Interoperability, or the capability to send data across health IT systems and receive it in a readable, usable manner should be the cornerstone of the healthcare industry’s efforts to transition to value-based reimbursement and population health management. No matter how quickly vendors are working to increase their interoperability capabilities, patients still face health information exchange barriers each and every day and their providers are still feeling cheated and hamstrung by vendor shortcomings. The transition has begun - the move from EHR implementation and adoption into an era of interoperability.

APIs make building applications and accessing data quicker, more efficient and less prone to duplication or security errors. However, healthcare systems with different data sets using different formats are making interoperability between apps challenging. The future of APIs in healthcare would depend on interoperability efforts such as The Argonaut Project and The Regenstrief Institute that continue to develop a data standard that can be implemented universally across healthcare organizations. APIs will be able to easily request and retrieve data from multiple EHR solutions across multiple healthcare organizations and arrange them in a clear usable format.

As API development continues, healthcare organizations looking to embrace better interoperability need a data management platform like Omni-HealthData that simplifies their burden of assembling health information from different systems while maintaining data integrity and providing valuable clinical insights.