HL7 is close to publishing the fourth milestone release of the FHIR standard at a time of increasing uptake that the US Office of the National Coordinator for Health IT recently said could soon approach critical mass. These are exciting times.
In their blog post, ONC's Steven Posnack and Wes Barker wrote that the US "might be at a turning point when it comes to the adoption and implementation" of HL7's FHIR standard, supercharged no doubt by the integration of the standard by mammoth companies such as Apple.
But there is still much to be done both here and internationally to get health systems sharing patient information and fuelling quality care – which is what our work is all about.
FHIR contains the foundation content for exchanging data about all parts of the healthcare process. It supports exchanging patient clinical summary, care plan management, medication management, diagnostic reporting, as well as clinical decision support, administration, financial management and even clinical trial administration.
[Read more: Catching FHIR: US ONC projects the data sharing standard to hit critical mass in hospitals and practices in 2019 | Apple announces new API for developers to access its Health Records data]
From the beginning, the mission of the FHIR community – which I am privileged to lead – has been to change the way healthcare is practiced by providing the technical infrastructure that allows applications to connect in new ways; ways that erode the barriers to improved care. We’ve seen other industries disrupted by the combination of technologies and the scalability the web offers, and we want to bring that to health.
I should be clear, at this point, that many of the barriers to improved care are not technical – there are massive cultural, political, legal and financial barriers to improving healthcare. FHIR isn’t solving those – it’s part of a wider movement to change the way healthcare works. But we, the FHIR community, think that what we have to offer is a game changer.
There’s no doubt that healthcare is a hard industry to change. Anyone who’s ever worked in the sector is all too aware of how hard it is to deliver meaningful change. On the other hand, anyone who’s worked in healthcare also knows just how much we need real meaningful process improvement. I’ve known this from when I first started working in a hospital, and watched how much churn is caused by information and coordination gaps. Things have improved in my working life but there’s a huge opportunity for us to do more, to make more of a difference.
[Read more: The titan enters the race: Apple to launch Health Records app with HL7's FHIR specifications at 12 hospitals | Australian FHIR innovation a frontrunner as the US government looks to standardise health data exchange]
We can now imagine an open ecosystem based on a commonly accepted data standard with well understood security and privacy management at the data exchange points of connection, and with a delivery mechanism for clinical decision support wherever it’s needed. A platform like this is one that empowers both care providers and care receivers by keeping them fully informed and able to easily manage their decision making.
I’m not claiming we’re there yet. There’s a long way to go before IT/IM solutions in healthcare routinely meet users’ expectations. But we do believe that our fourth release will be a solid platform from which we can start building this ecosystem.
And there is a window of opportunity here in Australia to leverage all of this into something useful.
As I write this, the Senate inquiry into My Health Record is due to report back on the direction of the platform. The MyHR, and the National Digital Health Strategy generally, intends to make good on the vision I outlined above. But our current reality is very different.
The system we have is based on an architecture that largely predates the emergence of the current web, and the gap between vision and reality is driving the current political challenges.
We’re about to reinvest in a new technical infrastructure for the national system – still based, for the moment, on the same central document repository architecture. That doesn’t make sense. If we’re going to invest, it needs to be in a solution that care providers and receivers want and demand so they can get improved health care and outcomes. Also, it should be an infrastructure that vendors want to leverage because its benefits are obvious and systemic. Let’s take this opportunity to pivot to a different architecture, one that can break down our silos instead of building new ones.
Saying that, though, real change is bottom up. We don’t have to wait for the Senate to decide the future of healthcare in Australia. The world is full of highly motived patients who want to get care differently – see Mike Morris’ story.
We’re all patients and we all need better care. Since there’s many barriers to improving care, there’s many opportunities to develop solutions to our challenges. FHIR is just one small part of that picture.
So, today, don’t wait. Ask yourself: how can I make a difference today?
Grahame Grieve is the creator and global project lead of HL7’s FHIR, and the principal of Health Intersections.