This is the second blog post in a 3-part series on advancing interoperability. See the first blog post, Interoperability—Yesterday, Today, and Tomorrow, and the third blog post, Supporting Interoperability During A Pandemic.
In our digital lives, we have become accustomed to apps and services operating almost seamlessly. If I miss a turn while following the step-by-step directions from my favorite navigation app, the system auto-corrects and presents a new route. Web apps like this are now so commonplace, most of us don't give much thought about how they work.
As providers, patients, and caregivers, we often wish our health information technology (IT) systems and apps worked that seamlessly. Far too often, the gaps in our fragmented care processes leave patients in the lurch.
Behind the scenes, while I’m following (or not following, as the case may be) those directions, my phone is performing its magic by leveraging a constellation of standards. For example, it uses GPS for getting geolocation information and HTTPS—along with a whole suite of Internet standards—for communicating securely with the remote server that computes possible routes from its vast cloud-based map platform. The application software itself (which may be developed by a third party) interacts with my phone's operating system, and the services on that remote cloud platform use application programming interfaces (APIs) that specify the format of requests and provide the responses back.
A passionate band of technology-minded health innovators are bringing that seamless connectivity of the web to health IT systems and applications. FHIR—which stands for Fast Healthcare Interoperability Resources—is a formal health data standard specification developed and published by HL7. FHIR applies the philosophy of the web to healthcare and provides a public domain, vendor-neutral API standard for health data that is transforming the health landscape. Rather than everyone doing it their own unique way, FHIR specifies a common approach to exchanging health data.
Since its first draft back in 2011, FHIR has seen widespread adoption throughout the health ecosystem. Current estimates show that approximately 96% of hospitals and 74% of clinicians in the U.S. have electronic health record systems (EHRs) with FHIR API capabilities. The Office of the National Coordinator for Health IT has issued a proposed rule that requires using FHIR as the API standard for enabling seamless and secure access, exchange, and use of electronic health information. Big tech companies including Amazon, Google, IBM, Microsoft, Oracle, and Salesforce have already publicly committed to using FHIR in their solutions for improving healthcare interoperability. Apple has embraced FHIR as the standard for bringing health data from various provider EHRs to your iPhone. And earlier this year, the National Institutes of Health issued a notice encouraging researchers to explore FHIR’s capabilities to use clinical data for research purposes and to enhance research data sharing.
With this level of market penetration, FHIR is clearly a technical success. But, as FHIR founder and visionary Grahame Grieve is quick to point out, its primary contribution isn't the technical standard. FHIR's real value is the community that has come together around it. The community is a large, diverse, and open group of people working together in a coordinated process to agree on how to exchange health data. Together, the community is producing a freely available, global public good whose value is shared among everyone and increases as more people contribute to and use it. I shared this perspective in my former role leading the development of the Logical Observation Identifiers Names and Codes (LOINC) terminology standard where we expressed our community values in the Manifesto for Open Terminology Development.