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Will You Be Burned by FHIR?
By Eliot Muir

The value of HL7’s newest standard may not be what you expect.

If you’re familiar with health care interoperability, chances are you’ve heard about FHIR, the latest emerging standard being developed under Health Level Seven International (HL7). Pronounced “fire,” FHIR stands for fast healthcare interoperability resources.

FHIR proposes to simplify the processes and ultimately reduce the costs associated with the HIT challenge of connecting disparate data among multiple health care systems. The new standard presents a common format for physicians to transfer patient information such as prescriptions, lab reports, or clinical assessments.

In 2011, HL7 created a task force to determine what direction the organization should take if it wiped the slate clean and examined interoperability challenges from a fresh perspective. FHIR emerged from this effort.

FHIR’s design is based on a straightforward representational state transfer (RESTful) approach, as is evident by the word “resources” in the name of the standard. FHIR represents a more granular way to exchange data without the workflow constraints of traditional HL7. With this kind of modular method, the idea is that each health care resource covers a small amount of coherent data, making it easy to build adapters that cover just the data required.

More importantly, FHIR attempts to address some real-world needs in the market, such as mobile- and cloud-based health care applications. FHIR has the potential to drive new efficiencies, but for it—or any standard for that matter—to be successful, it must be able to realize that potential.

Before There Was FHIR
HL7 version 2 solved a large problem for many people within the HIT industry back in the 1990s, replacing a variety of ad hoc data-sharing mechanisms used during that time. While version 2 implementations will be around for years to come, the standard lacks natural extensibility for the changing requirements of new data, so it has reached its logical conclusion.

Version 3, however, was doomed to fail from the beginning. It introduced a complicated, technically disruptive standard that lacked an equivalent market need. Complicated standards can be pushed for a certain amount of time, especially when government agencies mandate their use, but markets ultimately reject them. Version 3’s market penetration is a testament to this.

The Future Looks RESTful
It’s difficult to predict the outcome of FHIR. However, it already has made a significant impact. FHIR, backed by HL7’s efforts to promote it, is helping to make the paradigm of integration based on RESTful application programming interface (API) a mainstream concept. This is exciting because RESTful APIs are the simplest to implement. The trend to this type of integration is inevitable—in fact, it’s already happening.

In physician practices, HL7 integration already has become the exception rather than the rule. EMR vendors are encouraging integration through their own Web service APIs. So the question that remains to be answered is: Can FHIR be brought into the market fast enough to achieve adoption before de facto standards emerge?

While FHIR made it acceptable for conservative HIT companies and government agencies to take a serious look at RESTful integration techniques, the danger lies in the potential discovery that FHIR does not exactly fit with their data model. The challenge for FHIR is in demonstrating how it provides value above and beyond simply implementing a native RESTful interface, which reflects their application’s underlying data model.

In the end, the only standards that matter are those that are implemented. One way or another, one thing is clear: FHIR is transforming the health care integration landscape. By changing the way health care integrates, there is a real opportunity to not only improve the quality of care but also to improve many organizations’ health and profitability.

If the worst possible outcome for FHIR is that it fails as a standard but brings the whole concept of granular RESTful APIs to the forefront of the health care integration discussion, then it will be difficult to label it as a failure. As funny as it may sound to people in other industries, it’s a huge leap forward for health care.

— Eliot Muir is CEO of iNTERFACEWARE, a software company that seeks to simplify health care integration. He also speaks on topics such as disruptive technology and the future of health care interoperability.