Answers on FHIR®- Part 2

by: Russell Leftwich, MD, FAAAAI, FCCP the CMIO of the State of Tennessee Office of eHealth Initiatives

 This is the second of a two-part installment. Additional FHIR questions will be address in a blog post on Tuesday, April 14. 

Beyond the base Resources of the HL7® FHIR® standard and the Extensions there is the actual implementation of FHIR for data exchange using FHIR Profiles. Profiles are analogous to implementation guides.  They are created for specific use cases, including meeting policy requirements of organizations or jurisdictions.  They are constructs that include Resources, and may include Extensions, references to additional Resources, constraints on data types, vocabulary bindings, and other use case specific content.  HL7 will soon host a server where verified Profiles and Extensions will be accessible to FHIR developers and implementers.

The list of organizations that have plans for FHIR implementations, many of which are in pilot or live, continues to grow.  This rapidly growing interest in FHIR led HL7 to convene the Argonaut Project to Accelerate the Development of FHIR in late 2014.  This project was founded by a diverse group of vendors and healthcare organizations and continues to grow with commitment of new members.

FHIR also differs from past HL7 standards in the methods used in its development.   It is a community developed product that has leveraged social media – blogs, wikis, Skype – public FHIR servers and the openness of the Internet, with development pages on that include a link for comments on every page.  The FHIR standard is freely available through an open source license.  The rapid development of the FHIR standard has also been accelerated by the FHIR community by conducting several connectathons yearly the past three years with the number of these events continuing to grow.  The author of this blog entry has organized “Clinician Connectathons” at the HL7 Working Group meetings in September 2014 and January 2015 to inform the development of Clinical Resources in FHIR and to facilitate understanding between clinicians and implementers working on FHIR.

The evolution of FHIR is not happening in a silo. For example, Integrating the Healthcare Enterprise (IHE) USA is working with HL7 on SDC (Structured Data Capture) and DAF (Data Access Framework) standards under ONC’s direction to utilize both existing standards (SOAP, CDA and Consolidated CDA) and emerging standards (REST and FHIR) to improve data acquisition and access. The technical experts in the standards community are well known to each other, and they are working collaboratively to align these advancements in order to rapidly move the interoperability bar forward.

The anticipated publication of a Normative version of FHIR by HL7 by 2017 may seem ambitious, but the current pace of development driven by real world application of the standard makes this seem achievable.  One implication is that the HIMSS FHIR FAQ will need to be updated at a corresponding pace.

FHIR does not solve all problems of interoperability and exchange.  The complex issues of workflows around exchange, policies around data sharing, and security remain.  But the technologies upon which FHIR is built allow other existing technologies (HTTPS, SMTP, OAuth2, OpenID Connect) to be leveraged to solve some of these problems


About Mari Greenberger, MPPA

Director of Informatics at HIMSS North America
This entry was posted in HIMSS15, Interoperability & Standards and tagged , , . Bookmark the permalink.

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