When do you think FHIRAn HL7 standard that is short for Fast Healthcare Interoperability Resources and pronounced “Fire”. The standard defines a set of “Resources” that represent granular clinical concepts. The resources provide flexibility for a range of healthca... More 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 FHIRFHIR stands for Fast Healthcare Interoperable Resource. This emerging standard combines the best features of HL7 V2, HL7 V3, and CDA, while leveraging the latest web service technologies. The design of FHIR is based on RESTful web services. With REST... More 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. HL7HL7 is a Standards Developing Organization accredited by the American National Standards Institute (ANSI) to author consensus-based standards representing a board view from healthcare system stakeholders. HL7 has compiled a collection of message form... More is an international standard, so there is a long answer to when FHIR take off in various venues.

I think the ArgonautThe Argonaut Project addresses the recommendations of the JASON Task Force, a joint task force of the ONC‘s HIT Standards and Policy Committees and is a joint project between HL7 International and several vendor and provider organizations. The purp... More 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 EMRElectronic Medical Record (EMR), as defined in Defining Key Health Information Technology Terms (The National Alliance for Health Information Technology, April 28, 2008): An electronic record of health-related information on an individual that can be... More.

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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