Is New Zealand health IT ready for a FHIR takeover?

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Picture: Dr Russell Leftwich, senior clinical advisor, interoperability for InterSystems

NZHIT guest column by Dr Russell Leftwich, senior clinical advisor of interoperability for InterSystems

The FHIR standard has the ability to provide vastly simplified, accelerated and effective clinical information sharing between systems, creating opportunities for innovation in healthcare IT.

Thirty years ago, interoperability was a lot simpler. If you could exchange data between two IT systems, you had interoperability. But in the three decades since, the amount of data and the number of sources of data for an individual or a population have both increased exponentially.

Now, interoperability is about accessing data across many systems, both inside and outside the organisation, as a single, concordant view, and presenting it to clinicians in a way that is usable and actionable in their workflows.

HL7 Fast Healthcare Interoperability Resources (FHIR) is quickly becoming the foundation for the future of interoperability. The FHIR standard has the ability to provide vastly simplified, accelerated and effective clinical information sharing between systems, and it’s creating opportunities for tremendous innovations in the healthcare IT industry.

Not surprisingly, FHIR is a key topic at the HiNZ Conference 2018, New Zealand’s largest digital health event, being held in Wellington in November. In fact, HiNZ 2018 features what HL7NZ is calling the first official HL7 FHIR Connectathon, an interactive event in which participants can test their FHIR implementations and parts of the specification itself or simply learn more about this important new standard.

FHIR was also featured at the recent Health Informatics Conference in Australia, with two dedicated workshops, and it is bound to figure prominently at the international working group meeting of experts that HL7 Australia is hosting in Sydney in 2020.

And FHIR was once again one of the most talked-about themes at this year’s annual HIMSS conference, the largest health IT conference in the US.

There were more than 60 presentations on the standard at the show, compared with fewer than 10 sessions on the topic last year. I also personally saw vendors across the HIMSS show floor presenting FHIR-compatible capabilities and tools, leaving the older HL7 standards in the dust. That’s a clear indicator of how fast FHIR is growing.

A translation layer

However, while we can all agree that FHIR holds great promise for the future of interoperability, the industry shouldn’t jump ship too soon on the existing HL7 V2 and clinical document architecture (CDA) standards.

That’s not to say that FHIR won’t win out for building new systems (because it will), but I do believe that FHIR will need to coexist with other standards for the foreseeable future – the reason being there is no compelling economic argument to replace the billions of dollars’ worth of existing health IT systems that use other standards. What I do expect to happen is that FHIR will serve as a translation layer.

In fact, this was the first use we tackled at InterSystems – pulling HL7 V2 messages or CDA documents apart and storing them transiently as FHIR resources. Using FHIR as a translation layer – via a data platform that supports the latest standards, such as FHIR DSTU2 or FHIR STU3 – allows existing systems to take advantage of FHIR and its capabilities.

The reverse transformation can take place where data is exported from the platform back to systems that still only understand the older standards.

Strategy needed for hybrid standards environment

So, what does this mean for healthcare organisations? They need to be thinking about a strategy to live in this hybrid standards environment by implementing solutions that can operate with a variety of standards.

Rather than replacing or abandoning their existing technology investments in systems that are far from the end of their life cycle, organisations should look for solutions that aggregate data from a variety of systems operating with older standards – as well as newer systems based on FHIR.

Those organisations can then leverage FHIR to access that aggregated data, now represented in FHIR form, for analytics, decision support, clinical care and secondary uses made possible by the technology that underlies FHIR.

While there’s no need to jump ship on older standards, there’s an armada of FHIR-based capabilities heading our way, so it’s time to roll out the gangplank and get ready to get them on board.

Dr Russell Leftwich, is the senior clinical advisor, interoperability for InterSystems and adjunct assistant professor of biomedical informatics at Vanderbilt University School of Medicine.

To read more about the HiNZ Conference click here >>

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