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ONC’s 2nd Interoperability Forum Focuses on FHIR API, Faxes

Interoperability is still a challenge in health IT, leading to discussions on the future of the FHIR API at ONC's 2nd Interoperabiliy Forum.


Source: Thinkstock

By Elizabeth O'Dowd

- ONC’s 2nd Interoperability Forum, held this week in Washington, DC, focused on the future of the FHIR API in the healthcare space and the continued use of faxes to exchange health records.

The Fast Healthcare Interoperability Resource, or FHIR, data standard provides a way to aggregate and merge patient health data from separate data sources.

FHIR creates a standard to make it easier for healthcare professionals to use and share clinical data by restructuring healthcare data from different sources into a compatible format for interoperability.

FHIR was at the center of discussion because it has been several years since health IT developers have been working with the FHIR application programming interface (API), but there haven’t been a lot of real world successful applications of the standard.

The need for a healthcare API standard is clear, but that has not stopped health IT vendors from creating proprietary APIs, which defeats the purpose of having a standard. If every healthcare organization is using different proprietary APIs, then the interoperability challenge of exchanging data among different health systems is not being solved.

FHIR users that are implementing different versions are “preventing true interoperability,” said Intermountain Healthcare CMIO Stan Huff.

The overall attitude about FHIR was pessimistic. Politico reported that healthcare interoperability challenges are far from over, and the continued lack of standardization of FHIR is preventing organizations from achieving smoother data exchange within their own organization and among other health systems.

This revelation does not mean that the promise of FHIR has dimmed completely in the API world.

Apple demoed its personal health records solution. Apple Clinical and Health Informatics Lead Ricky Bloomfield MD called it “a real FHIR app,” and commented that he was “tremendously optimistic about the health IT ecosystem today.”

Apple is continuing to expand in the healthcare industry. Apple has filed over 50 patents that will allow the iPhone to be used as a medical device to track patient health.

Apple has also entered the EHR space with its Apple Health Records EHR data. Bloomfield explained that the tool uses FHIR to aggregate, display, and exchange health data.

In addition, Microsoft’s healthcare-related patents include expanding its AI technology to help monitor chronic disease.

Quest Diagnostics is doing a lot of manual outreach to collect data and deliver lab results to patients. The lab company is looking to FHIR to improve this process by making it easier to streamline data.

“FHIR, there’s so much opportunity,” Strategic Health Information Exchange Collaborative CEO Kelly Hoover Thompson was quoted by Politico as saying. “I think there’s more development to come. The more advanced [HIEs], they’re looking at it, they’re trying to incorporate it.”

In addition to discussions about FHIR, another topic of interest at the forum was how organizations are still using fax machines for data exchange.

While digital is the preferred format for health records, many organizations are still hooked on the security a fax machine offers. Sending a record using a telephone transmission instead of using email or uploading it is arguably more secure, but it takes up valuable clinician and administrator time as well as resources.

CMS head Seema Verma stated during her keynote address on Monday that she wants to have all provider organizations fax-free by 2020.

“Once information is freely flowing from the patient to the provider, the advances in coordinated value-based and patient-centric care will be even greater than anything we can imagine today,” said Verma.

ONC’s Steve Posack declared that October 12, 2018 will be “No Fax Friday” to encourage organizations to seek alternative digital ways to securely exchange information.

Eliminating fax and encouraging FHIR are two ways CMS plans to improve healthcare data exchange in the coming years. Getting rid of old technology like fax machines will help organizations exchange data more quickly without wasting resources. And embracing FHIR as a standard will help organizations securely exchange data for the convenience of the patient and care provider.


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