Several years ago, the New York eHealth Collaborative (NYeC) began to work on interoperability issues by enabling document sharing across the state’s regional health information organizations (RHIOs). Now NYeC is shifting to a FHIR foundation to enable participants to access discrete pieces of patients’ clinical information through open application programming interfaces (APIs).
NYeC is a nonprofit organization leading the Statewide Health Information Network of New York (SHIN-NY), a network connecting all of the RHIOs. They are interconnected through a SHIN-NY hub via a statewide patient record lookup.
Speaking June 15 at the HL7 FHIR DevDays virtual meeting, Luke Doles, NYeC’s senior director of services management, New York eHealth Collaborative, first described some of the limitations of the document-centric approach based on an IHE/XCA architecture. The initiative began in the second quarter of 2014, and was not live until end of the fourth quarter of 2015. It required nearly 18 months of design, testing and implementation. There were several issues that had to be worked through, including with the size of documents. “We do weekly production testing with all the RHIOs and it is rare that the document exchange is 100 percent successful,” he said.
“Even if a clinician wants only some discrete data from a document, the entire document has to be retrieved, then parsed to get specific data,” Doles explained. “This is done for patient cohorts and reported back to care management organizations for specific lab values and vital signs. This is a very cumbersome process.”
Last summer NYeC began building a FHIR framework across the RHIOs. “This involved each RHIO setting up a FHIR endpoint,” Doles said. “This would allow the same functionality as receiving a document and parsing for discrete data except with much lighter-weight transactions and hopefully greater reliability. We would still retrieve data centrally using the record locator service and then aggregate FHIR responses into a single bundle per patient.”
As they began the work several RHIOs leveraged their HIE vendor for FHIR, but some had to do development from scratch. The FHIR resources were created pulling specific data from the RHIO’s clinical data repository. A primary use case was to retrieve data for a patient cohort such as the last A1C lab result or vital sign such as blood pressure. For this use case, they limited the required FHIR resources to Patient, Condition, and Observation.
The initial FHIR framework was in production in about 8 months, compared to the 18 months required for IHE/XCA implementation. “The limited implementation allowed us to get the FHIR endpoints in place and provide a mechanism for the initial use case,” Doles said.
“Unfortunately, we have not been able to fully execute the initial use case because of demands for data from the RHIOs to help with the COVID-19 research and reporting. The FHIR framework was not quite ready to provide that support. Now we are planning to build on the initial FHIR framework over the next year to support these public health use cases for things like COVID-19 reporting and flu surveillance. This will be a centralized pull of data that will be aggregated and delivered to the Department of Health.”
Eventually NYeC wants to enable RHIOs to be able to do specific patient queries from their HIE through the centralized services and receive responses via FHIR resources. “This will give the RHIOs the greatest flexibility to use the framework for their own initiatives,” he said. “Even though this was a limited implementation of FHIR, it was a proof of concept that can be incrementally expanded upon to provide more functionality across the SHIN-NY.”