HL7 FHIR when ready

May 22, 2014
When you think about the massive impact technology has made on how we approach and solve problems, it is incredible.  A quick web-ex meeting enables us to instantly share desktop screens, files and images, while we simultaneously talk through complications and work through roadblocks with coworkers or clients halfway around the globe. In healthcare, when electronic health record (EHR) implementation caused a decline in physician productivity, the introduction of speech recognition was a game-changer, streamlining workflows, improving EHR adoption rates and removing the complexity of check boxes and the need for structured data.  Sometimes the simplest solution is the best, and while speech recognition tools are widely used by physicians today to speed the communication of information, in other areas of healthcare, things have stalled. What is truly remarkable is that when it comes to the transmission of vital, life-impacting information in healthcare, especially communicating X-rays, CAT scans and other patient images, we might as well be using carrier pigeons to communicate.

As a society that is always looking for “the next big thing,” we constantly think about ways to build upon existing technology to create something better, but sometimes there is lag between vision and execution. Arguably, no industry feels this painful gap as keenly as healthcare. The primary goal of healthcare organizations, after all, is delivering the best care to their patients. Everything else comes second. Outdated systems, incompatible platforms, disparity in employees’ IT savvy, and lack of time and resources have created a perfect storm of frustration for physician practices, hospitals, clinics and health systems alike – regardless of size or revenue.

Unfortunately, in our current healthcare system, barriers to sharing information often are tied to technological incompatibility or systems that don’t talk to each other. In fact, Dr. John Halamka, CIO at Beth Israel Deaconess Medical Center and Co-Chair of the Federal Health IT Standards Committee, recently remarked to Dr. Keith Dreyer, Vice Chairman of Radiology at Massachusetts General Hospital at a technology panel, “Our institutions are actually 50 feet away from each other. How often in the last 10 years have we exchanged images electronically between our two institutions? Not so much.” Although this elicited a laugh from those in attendance, the underlying truth is unnerving

And that is what is so promising about HL7’s Fast Health Interoperable Resource (FHIR) initiative. While some have pointed out it is too flexible to be a standard, I would note its intrinsic value to healthcare. It allows organizations to develop customized bridges between systems, leveraging cloud-based apps and device integration to drive more tailored workflows for clinical teams. The end result is better information in less time, collaborative care and better patient outcomes.

In radiology, we are starting to see the benefits of interoperability with image-sharing networks, which are being used to exchange billions of images between clinicians, patients and healthcare organizations to participate in collaborative patient care. Relying on the simplicity of social networks, image-sharing networks enable an individual to upload images and reports to a secure, cloud-based server and share a link for that particular image with a physician, specialist or other relevant party. These images are available to ordering and treating clinicians within their electronic health record (EHR) workflow. This simple interface removes the need for a user to log in to a virtual private network (VPN) or on-premise servers, which can be expensive and complicate the process.

With such a long and costly history of cumbersome health IT technologies, it is not a surprise that organizations are skeptical of health information exchanges (HIE). It will take small steps and carefully thought-out processes, but it is clear that we are heading toward light-weight interoperability that will use different modules that can be integrated into the EHR to provide instant access to life-saving data. –Nuance Communications

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