Plentiful is the health IT industry with FHIR discussions and opportunities. It’s on everyone’s topic boards, it’s being pitched at all of the health IT conferences, it’s being discussed and used time and again in SDOs, apps are being developed, initiatives are born. And it’s possibly near a tipping point of success.
HL7/IHE History around FHIR
IHE and HL7 have a long history, going back to the beginning of IHE in 1998 (HL7 was already in existance). There have always been collaborators across and between the two organizations. This is, effectively, how IHE begun. A bunch of health IT standards geeks were seeking a new way to provide interoperability guidance to the world, and thus IHE was born. So it’s not surprising that pattern has continued into the era of FHIR. It started with ad-hoc liasons between the organizations, taking a set of FHIR resources into an IHE Profile, or taking requirements from an IHE Profile back to HL7 to create or modify an existing FHIR Resource. The value of FHIR was quickly recognized as a market disruptor, and as such IHE and HL7 begun to explore the idea of formal collaboration more seriously. These organizations are big ships, and they turn slowly, but over the past 6 years, they seem to be turning in the right direction.
In 2013 HL7 and IHE drafted and signed a Statement of Understanding to identify many areas of collaboration between the two organizations. While this SOU did not make specific mention of FHIR, I strongly suspect FHIR was a driving factor in the agreement.
In 2014 the IHE-HL7 Coordination Committee and the Healthcare Standards Integration (HSI) Workgroup were both created. The former in IHE, the latter in HL7. These were intended to be “sister groups” to work with each other helping to improve collaboration for both organizations, leading to greater efficiencies for all involved. These groups languished a bit and never really got enough traction to continue in the way they were originally envisioned.
A few years later, in 2017, IHE created and IHE FHIR Workgroup that continues to meet today. This workgroup is focused on how to include FHIR in IHE Profiles and has very detailed guidance on this documented on the IHE wiki. It also tracks IHE Profiles using FHIR, cross-referencing across IHE Domains. This workgroup has produced materials and guidance that is very helpful to bringing together IHE and FHIR.
In 2018 Project Gemini was launched, named after the space program of years ago. It’s goal is to identify and bring to market pilot project opportunities based on FHIR. It will leverage and potentially create specifications, participate in testing activities, and seek demonstration opportunities. Basically, it’s job is to tee up FHIR-based projects so they can be launch into the outerspace of the health IT ecosystem. Interoperability is often big, expensive, and scary to implementers and stakeholders – similiar to the challenges that NASA’s Project Gemini was facing.
We are on the cusp of pitching into a new era in health IT with the forthcoming of FHIR. While FHIR will not be a silver bullet, it does provide a great opportunity to be disruptive, in a good way.
IHE PCC and QRPH – Profiles on FHIR
The PCC and QRPH domains have been working on FHIR-based IHE Profiles since 2015. PCC has a total of 9 Profiles that include FHIR, and 1 National Extension, and is working on updating 1 of those Profiles this development cycle to include additional FHIR Resources. QRPH has a total of 4 Profiles leveraging FHIR, with 1 new FHIR-based Profile in the works for this development cycle.
One observation that we have made within PCC, and this is also being used in other domains, is the importance of retaining backwards compatability for our implementers by adding FHIR as an option to the menu. It is not a wholesale delete old and bring in new situation. In fact, if we followed that approach then standards would likely never be implemented en masse as they would always be changing. So an IHE Profile that uses CDA today, and that is under conseridation for FHIR will be asssed by the IHE committee to determine if it should add FHIR as another menu item, or perhaps a more drastic measure should be taken to deprecate the “old” technology.
This will obviously vary based on a number of factors, and that’s a topic for another post, but the point is that the default goal for improving existing IHE Profiles with FHIR is not to replace everything in that Profile with FHIR. Rather, it is to assess each situation and make a wise choice based on what’s best for all involved (vendor implementaters, stakeholders (patients and providers), testing bodies, governments, standards bodies). This does not mean that everyone is happy all the time, but all angles must be considered and consensus is desired.
Implementation of IHE and FHIR
FHIR is being implemented in various ways across the industry. There are two very significant initiatives happening right now that are well-positioned to launch FHIR into the outer space of health IT: CommonWell Health Alliance and Carequality. Both iniatives have been around for roughly the same amount of time (CommonWell 2013, Carequality 2015), and focus on the same general mission to improve data flow in support of improving patient health outcomes, but they take different approaches to get there. CommonWell provides a service that members leverage to query and retrieve data, whereas Carequality provides a framework, including a governance model to do this.
These are fundamentally different approaches but both are achieving great success. CommonWell touts upwards of 11,000 healthcare provider sites that are connected to their network. Carequality touts 1,700 hospitals, and 40,000 clinics leveraging their governance model to exchange data. These are big numbers, and both organizations are on a trajectory to continue increasing their connectivity. CommonWell already has FHIR fully embedded as an option is their platform, with the ability for a member to only leverage REST-based connectivity (most, if not all of which is based on FHIR) to fully participate in the Alliance’s network. Carequality currently has an open call for participation in newly forming FHIR Technical and Policy Workgroups to include FHIR as a main-line offering in their specifications.
Given that both of these initiatives have included IHE as part of their original implementation requirements, and that both are now including FHIR, and that both have signifincat implementation numbers – we have an exceptional opportunity to advance interoperability in ways that we have not been able to previous.
The world of interoperability is alive and well, despite constant setbacks (due mostly to non-technical things), and thanks in part to IHE and FHIR. Convergence is happening, both on the SDO front as well as in the implementation world. And I fully expect that convergence to continue.