Hackensack University follows FHIR-enabled route to data exchange

After his daughter suffered a concussion last year, Shafiq Rab, MD, CIO at Hackensack University Medical Center, saw how a lack of coordination and data exchange complicates the patient experience. “We had to go to the primary care physician, a neurologist, a vision doctor, a physical therapist—and I became the care coordinator,” he says.

The frustrating experience intensified Rab’s desire to use technology to improve healthcare delivery, helping patients and caregivers seamlessly connect and share information whenever and wherever they need to.

Toward this end, Rab and his team just released a Hackensack University app, which enables patients to make appointments with participating physicians, fill out forms, and access test results—all on their handheld phones or devices.

Rab and his team have also been busy transitioning to Fast Healthcare Interoperability Resources (FHIR), HL7’s web-based standard aimed at facilitating data exchange. Adopting FHIR, which Rab calls “Bluetooth for healthcare” is helping Hackensack University share information across disparate IT systems and devices.

For instance, physician practices that do not share the medical center’s Epic system now receive alerts directly in their electronic health records (EHRs) when a patient visits Hackensack University’s emergency department. Before, these physicians had to be alerted by fax, phone or HL7 message.

Last summer, Hackensack University became one of the first U.S. health systems to sync patient’s blood glucose monitors, home scales, fitness trackers and other devices to its EHR, using the Apple HealthKit app and the Track My Health section of the Epic MyChart app. It’s little wonder that Rab in 2015 was awarded the Innovator of the Year Award from the College of Healthcare Information Management Executives.

Early on HUMC recognized the potential to utilize their existing interface engine that currently facilitates the exchange of HL7 messaging among their existing systems. They then approached their interoperability vendor, Infor, to work with them to evolve the technology to leverage the capabilities of FHIR. Infor engineers worked closely with their counterparts at HUMC to build out the technology components that implemented FHIR DSTU 2 Patient Resources to communicate with mobile devices. Together, these two organizations achieved one of the first commercial applications for FHIR.

Down the road, Rab and his team aim to embed live video into their app, enabling physicians and patients to communicate remotely in real time: “When referring a patient, the doctor could press a button and introduce the patient to the other doctor via video,” Rab says.

Yet Rab is a realist. He says repeatedly: “Technology is exponential, and healthcare is linear.” In other words, “People have to catch up to it.”

Reflecting on the year-long process of becoming FHIR-enabled, Rab says, “The technology part was easy.” The hard part, he says, was building consensus among key stakeholders—senior leaders, physicians, vendors, and others—around a vision of using IT to deliver healthcare wherever and whenever the patient needs it. “We went to the doctors, we went to the nurses, we went to all the powers that be and constituent people to let them know what we wanted to do and that they have a role to play in this,” he says.

Hackensack University was already further along in data exchange than many health systems before adopting FHIR. The hospital and many physicians were already on the same Epic EHR. To share information electronically with non-Epic users, Hackensack University had been using direct HL7 feeds, its private health information exchange and Jersey Health Connect, the regional health information exchange.

Rab credits these earlier steps toward data exchange as small wins that helped physicians and others see the benefit of interoperability and embrace further improvements. FHIR is a step forward in fulfilling the organization’s discrete data needs,” says Rab, explaining that FHIR enables specific data elements to be exchanged. For instance, when IT systems are FHIR-enabled, a physician can send a query to obtain a patient’s list of allergies rather than having to obtain and scroll through a patient’s entire continuity of care document.

As a participant in HL7’s Argonaut project, Hackensack University is helping to pilot test and improve the FHIR standard. Jeremy Marut, director of enterprise architecture, remembers being introduced to the Argonaut crew at a recent HIMSS conference. “They brought me down to this little dark room. Inside, there were people from the White House and CMS [Centers for Medicare & Medicaid Services], Harvard, Google and every single big vendor. And I realized, ‘There is something really major happening here.’ ”

After committing to Argonaut and downloading the FHIR resources, Rab and his team began working with IT vendors—including suppliers of the health system’s interface engine, EHRs, private HIE and population health software—to help them become FHIR-enabled, too. At times this involved getting representatives from all the companies together via video chats, phone and email to figure out the best path forward.

To date, Hackensack University is enabled for nine of the 99 FHIR resources. There is still a lot of work ahead, but Rab and his team plan to rely on three traits that have driven them so far: a readiness to make and learn from mistakes, a service mentality and—most important, says Rab—passion. “Healthcare will not change until people like us stand up and fight for it with passion and with a commitment to make lives better,” he says.