Grieve: FHIR has disrupted health IT, but not healthcare

HL7’s Fast Healthcare Interoperability Resources standard has succeeded in disrupting health information technology and standards, but not healthcare’s “broken” processes.

That’s the contention of Grahame Grieve, architect of the open health data standard and HL7’s FHIR product director, who spoke earlier this month at the Regenstrief Institute.

“Our goals are threefold—to disrupt healthcare IT standards, to disrupt healthcare IT and to disrupt healthcare,” Grieve told the audience. “We set out to disrupt healthcare IT standards—that’s in the bag. We set out to disrupt healthcare IT—that’s changing. We want to disrupt healthcare—that has not started yet. Our focus now is turning more to healthcare rather than healthcare IT.”

With the publishing earlier this year of the “normative” version, FHIR has emerged as a mature, stable standard forming the basic application programming interface (API) building block for common healthcare transactions.

Not surprisingly, the Office of the National Coordinator for Health IT has proposed a rule that—for the first time—seeks to make FHIR a requirement for developers participating in the ONC Health IT Certification Program.

Also See: Proposed ONC rule requires FHIR interoperability standard

Given these recent developments, FHIR has tremendous potential to serve as the core functionality to support data access in healthcare enabling health information exchange.

“FHIR is the web for healthcare,” said Grieve. “It’s an open community based around web technologies, web techniques and web philosophy.”

As a standards framework, FHIR leverages RESTful APIs to enable data sharing among myriad health IT systems. By using the latest web standards, FHIR is seen as a simple-to-use format that can improve interoperability for a range of HIT technologies, including mobile apps, cloud communications and EHR-based data sharing.

“We need to start thinking in terms of clinical interoperability,” added Grieve. “It’s a clinical problem, it’s a human problem and a record-keeping problem. It’s not a technology problem, and we should just stop talking about technology. We now have an information management, workflow, record-keeping problem.”

According to Grieve, other industries have been transformed in the past decade, and IT has enabled that transformation. However, he contends that healthcare is an outlier.

“We set out to remove IT as a barrier to seamless care, but there’s lots of other barriers and problems,” Grieve concluded. “Solving the IT problems along with the wider societal changes around IT will tilt the playing field. And, everyone will start sliding towards better seamless care.

“The ride forward is going to be very, very bumpy as people disintermediate clinical processes, healthcare funding arrangements and start eroding the effectiveness of the cross-subsidization that is ubiquitous in healthcare,” he added.