When do you think FHIR will be used by average U.S. hospitals? What are the typical workflows that will be supported, and will FHIR replace V2?

Answer from HL7 FHIR Governance Board Co-Chair and Corepoint Health CTO Dave Shaver:

Great question. I think the key part of that question is to focus on the U.S., which is also where Corepoint Health is located. HL7 is an international standard, so there is a long answer to when FHIR take off in various venues.

I think the Argonaut Project is pushing hard enough and fast enough that we're going to see the use of FHIR in the context of smart apps this summer.

I think that will begin with read-only access. These will primarily be smart apps like a growth chart, or a heart disease risk profile kind of environment. And then moving up to more complex examples, like one of the applications that's going to probably be one of the first that has read/write access to Cerner that allows a patient to track through the web, track their pain in various joints and then to feed that information in a caregiver-centric way back into the EMR.

So that means that, for example, a picture or PDF can be produced, and that resource can be published back into Cerner. There are some authentication questions with FHIR that need to be ironed out, but these examples include patients that have already been authenticated, and we're trying to pull information in to augment the data that already exists in the hospital or to view the existing information in another way.

The next phase of this will be inside the four walls of the hospital and involves leveraging that source of truth – that data that's sitting in my EMR or in my lab system or in my radiology system. Allow me to query that source of truth on my own schedule – on my own workflow – rather than a predestined workflow from an HL7 v2 perspective. And then allow a vendor to produce a capabilities-based interface, which all can be accomplished using an interface engine.

So we looked at Epic's example. These are query parameters that I'm able to do, that let me do a particular type of search for a patient. This is a capability statement that says 'Here's the version of FHIR and the capabilities that Epic supports.' How you use this, how you use the results that come back are not predestined, which is the cool part of FHIR.

Now imagine if you have a version of Epic or a version of Cerner and you would like to get a list of the current medications and prescriptions for a particular patient. Tather than having to log into Epic, you authenticate and you're able to use that data however you see fit within your own four walls.

I think in the next two to three years we're going to see the beginnings of simple applications that are able to read and write to the Epic and Cerner databases of the world.

And I think five years out we'll have solved the authentication questions that remain and we'll have more access remotely. But clearly we have to solve governance problems. We're rightfully trying to crawl and walk before we run in terms of the FHIR specification.

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