FHIR Communication: The Role in Improving Healthcare Provider Dialogue
Having the ability to communicate effectively is essential, especially during a crisis. This requires sharing information in a manner that all can understand. One concern the COVID-19 pandemic highlighted was the need to share public health data and information between healthcare providers and departments at the county, state, and federal levels so leaders can make decisions, provide support to hot spots, and mitigate the spread of the disease. However, this is not as easy as it sounds.
In many ways, it is illustrative to think about the old origin myth and the Tower of Babel. This story shows the importance of communication and the massive difficulties organizations face when they cannot speak the same language. And when it comes to sharing and collecting data from various systems, having a lack of smooth communication can lead to complicated and costly corrections, information bottlenecks, mounds of manual labor, and the potential to create errors.
Several software platforms use existing standards to organize shared data while new ones are in development. The dominant format for healthcare providers, like hospitals and public health units, is Health Level Seven, or HL7. It was developed in the late 1980s with an agreed-upon standard created by a group called Health Level Seven International. These rules and standards encourage various healthcare providers and units to share information uniformly, eliminate highly variable data sets, and reduce the amount of clerical work.
However, Health Level Seven International has been working on its next-generation system called Fast Healthcare Interoperability Resources, or FHIR. It is built on top of HL7 and expands on how data is modeled while being easier to implement, more open, and extensible. Both FHIR and HL7 are document-based systems that offer a standard structure to represent data.
One of the biggest changes FHIR brings is the use of modern web-based technology like RESTful API. This software architectural style was created to upgrade performance and reliability while allowing for it to be modifiable and enforce security protocols. REST is a standardized method to communicate and share information between systems. It organizes data into “resources,” where a patient’s name or date of birth can be a resource, their immunization status is another resource, and so on.
The metadata in a resource creates a universal locator that allows any changes made to be updated directly in the patient’s electronic health record (EHR). So, for example, if a patient gets a COVID booster shot, that particular immunization resource would be updated in the patient’s file immediately, without having to send the entire document. This improves the speed of information transfer and is safe and secure.
FHIR also supports many web-based representations like JSON, XML, and RDF, which help it be interoperable with many systems used throughout the healthcare space.
There are challenges to adopting FHIR, specifically in ensuring interoperability with other systems. That is why clear and concise implementation guides are critically important. Several groups in the industry are working on the various sub-domains to define and develop standards on how they can represent data for factors like cancer, immunizations, or other medical treatments. They must reach an agreed-upon format because using multiple ways to represent data will lead to interoperability issues in the future.
We are working with our clients to implement these new standards in FHIR while they are still being created. Additionally, we are examining how various states want the information to be organized, to help us guide our clients in the right direction and ensure interoperability in the future.
The power of FHIR is that it standardizes the representation of data and the protocols to support interoperability. Once a critical mass of healthcare organizations adopts it and implements it uniformly, it will be quick and easy to share and update information. This speed will help doctors get test results sooner or allow leaders to pinpoint trouble like the next pandemic, disease clusters, or areas where there might be environmental risks such as lead poisoning. Having public health software solutions that can communicate with each other is essential for an effective healthcare system.