Australian-developed open source technology FHIR could soon be standardised for health information exchange by the US Government in a move that would propel the giant EHR companies and healthcare providers towards data sharing.    

Following Apple’s January announcement that it was adopting the FHIR API in its new Apple Health app, the fast-tracked democratisation of data exchange could vanquish siloes and place information in the hands of individuals, according to Bruce Greenstein, Chief Technology Officer of the US Department of Health and Human Services.

“We've made some progress on health information networks but not at the level that we really want. So I think that what you'll see come out of HHS this year with regard to the Trusted Exchange Network and work on interoperability that will move all the EHR and other health information companies in the right direction,” Greenstein told Healthcare IT News Australia.

“We’ll decide on standards, on whether they’re FHIR API right here from Australia or another standard.”

Although HHS is “not likely to be overly prescriptive on this,” cultural change warrior Greenstein said government and industry pressure would lead to Americans being provided with easy access to their health information.

“You'll see some mandates that Congress placed and we'll carry them out. For example, individuals should have access to their health information without ‘any special effort’. So that means that from your hospital or from your doctor you have to have a way to get to your health information and the best way to get to that is going to be an API and some kind of presentation layer,” Greenstein said.

In its January announcement, Apple committed to an open API for health records – the Argonaut Project specification of HL7’s FHIR. Billed in the industry as a game-changer, the might of the tech titan will pressure electronic health records systems to deliver health information in accordance with the standard. Consumer apps will be built to harness the wealth of data. The many millions of iPhone users globally will also come to expect access to their records.

“Apple's already moving in that direction, and so we think that there's going to be enough pressure put on the provider side that will incent individuals and make the barrier to entry very, very low and we'll start to see some real action in this area.”

A vast department of over 80,000 employees – which is responsible for the nation's public health system, Medicare, Medicaid, biomedical research, and food and drug control – HHS spends $1.15 trillion dollars a year, an eye-bleedingly high figure in Australian terms, but Greenstein said that's just a third of the cost of healthcare in the US. Also substantial is the influence HHS wields.

“It's an incredible privilege to have a job as the chief technology officer and the idea that we're making progress in deregulation, making it easier and more structured to be able to exchange data, pricing information to get it out into the hands of consumers and businesses. The idea is to give people the ability to make better decisions and that's a piece that we have a great deal of influence on.”

About 95 per cent of the country's healthcare providers have an EHR and now the challenge is getting the data contained within them to provide clinical benefits, economic rewards and individual control.

“We had such rapid adoption that now we're going back to make sure that providers are getting the most out of it and that consumers patients can get their data out of it. And so you're going to see over the rest of this year in 2018 a lot of strides in interoperability and so the standards that we're going to move the market towards will make it much easier for individuals to get their data out of systems.”

He described it as an exciting and developing area of the US’s digital health economy.

“The next piece is setting up sort of the swim lanes around the way that providers and companies exchange data with our trusted exchange network. We're utilising our existing infrastructure – we have health information networks and other organisations like that – and then we provide some rules around that to allow this exchange of information to happen in a much better way.

“Then we do it in a way that provides a real marketplace and business opportunities because then the value comes from what you can do with the data and that provides also some sustainability for this piece of the market.

“So we're likely to see new companies come out of that experience, existing companies will do more with releasing the data and then individuals will have the power of getting their data through APIs that then they can action on.”

Greenstein described the spend on healthcare in the US compared to GDP as “too high” and said moves to roll back some regulations and stimulate business investment are working. Lowering or removing Food and Drug Administration hoops for routine digital health apps are already attracting more companies from adjacent markets into the healthcare pond, he said.

For the Trump administration, innovation and entrepreneurialism will save the government and healthcare providers money, create opportunities for companies and investors, and lead to improved healthcare.

“In regard to the way we treat open data, this administration is very bullish on using open data to grow the economy and it's not a political issue. It's an issue that says if we can get more information out in a private and secure way then we’ll light up parts of the economy by seeding new companies, seeding new solutions and ultimately giving us better patient care and more efficient patient care.”

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