AUTHOR: Tom Bowden, CEO, HealthLink & Vice President, MSIA
Many healthcare IT aficionados think of interoperability as a ‘magic broom’ that will sweep healthcare’s problems magically aside, connecting IT systems to one another and finally bring the benefits of information technology to an industry stuck in the nineteenth or twentieth century.
Alas, interoperability is a little more complex than that. More realistically interoperability should be thought of a process of knitting together systems so they talk to one another and in a country such as Australia, government has a vital role in determining which standards should be used and exactly how they should be combined – setting this out in as straightforward a manner as possible,
One of the key aspects is setting interconnection standards. Government’s role should be to help industry to choose the right standards and then to ensure they are implementing them correctly.
In the first of a series of commentaries on clinical messaging we look at the emergence of FHIR – The Fast Health Interoperability Resources standards, the latest approach to interoperability emerging from the Health Level Seven (HL7) organisation. FHIR is an innovation that many people think may be a significant leap forward. FHIR has a distinctly Australasian flavour. FHIR is the brainchild of Graham Grieve who is credited as being the evil genius who brought it to fruition.
For many years Anzac cousins Australia and New Zealand have argued good-naturedly over various Australasian icons Pavlova, Pharlap, Russell Crowe, Split Enz all belong to the Kiwis (according to them). The latest dispute is over the “ownership” of HL7 Guru and principal FHIR originator Grahame Grieve. In his younger years (perhaps while planning a parliamentary career) Grahame became an Australian citizen, renouncing his Kiwi roots, however in a final twist to the tale, Grahame has revealed that he was in fact born in Australia and moved to Dunedin as a child, before finally making his mind up and returning to Australia for good.
Firstly, who or what is HL7?
Health Level Seven (HL7) is an organisation set up by Duke University in 1988 to standardize the means by which healthcare’s computer systems could talk to one another.
This endeavour took an unexpectedly rapid upward turn with the discovery of a highly successful proprietary electronic data interchange format. This was further developed and became known as HL7 v2, the world’s most widely used electronic data interchange (EDI) standard -in any industry sector.
HL7 version 3, was a very promising failure. Entire countries spent huge sums of money trying to implement it and saw it collapse under its own weight. HL7 v3 was an attempt to utilise the highly successful extensible mark-up language (XML) as the basis for developing a new language for health information exchange. General consensus is that the engineers ran amok with it and it became far too complicated.
When the dust settled, only one useful component emerged and that was Clinical Document Architecture (CDA) which is enjoying modest success in a number of countries, Australia among them.
CDA (for managing documents) and HL7 v2 (for exchange of simple clinical messages) are likely to remain in place for the foreseeable future.
And where does FHIR fit into the picture?
Interoperability is becoming about accessing data across many systems, both inside and outside the organization and presenting it to clinicians in a way that is usable and actionable in their workflows.
The FHIR standard has the ability to provide vastly simplified, accelerated and effective clinical information sharing between systems and it is catching on fast.
Vendors are busily developing “FHIR-compatible” capabilities and tools. However, while we can all agree that while FHIR holds great promise for the future of interoperability, the industry shouldn’t abandon the existing HL7 v2 and CDA standards.
FHIR will need to coexist with other standards for the foreseeable future. For a start, there is no compelling economic argument to replace the billions of dollars’ worth of existing health IT systems that use other standards.
It is likely that FHIR will become a translation layer, pulling V2 messages or CDA documents apart and storing them as FHIR resources. Using FHIR as a translation layer will allow systems to take advantage of FHIR and its capabilities.
Healthcare organizations need to be thinking about ‘a strategy for a developing hybrid standards environment’ by implementing solutions that 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 lifecycle, organizations should look for solutions that aggregate data from a variety of systems operating with older standards – as well as newer systems based on FHIR.
So please go ahead and develop innovative uses for FHIR but I strongly suggest that you do not view it as a ‘rip and replace opportunity’ but rather a new tool that you can add to your interoperability toolkit.