In my role as Director, Interoperability and Standards with NantHealth's NaviNet Open team, a good part of my job is spent exploring the Healthcare IT landscape to identify, advocate and decide where we should invest our resources. With that said, if an organization, acronym or trade group exists to enable interoperability in health care, chances are I’ve crawled their website, sat through a webinar, interviewed their CEO, and/or talked to practitioners or users of their assets. My investigations continue to pull me back to HL7 and FHIR, as our organization has recognized that providers and payers increasingly need to pull disparate data from administrative and clinical workflows together.
Big Bang Is Not My Thang
To be clear, a large reason I’m in this role is because I’m a pragmatist by nature. After painful lessons in my early career, I tend to avoid the “big bang” release, the “end-all, be-all” perfect solution that never actually gets implemented. I, like many of you, learned that in order to achieve lofty, long-term goals, you need to make hard decisions on what is “good enough” for initial releases. I believe in, and continually advocate for, small incremental change as the vehicle for revolutions.
Is FHIR Just Hype?
Why so philosophical? I expected to find ivory tower thinking and “irrational exuberance” as I dove feet first into the world of FHIR last June. New technologies often go through a “hype” cycle and at first glance it appeared that FHIR was following a similar trajectory. While at Health Datapalooza last June, I even giggled out loud when Charles Jaffe, the CEO of HL7, showed the inevitable “trough of disillusionment” that FHIR must need to pass through as the industry comes to understand what is/is not possible with this emerging technology. What is clear is that many are still talking about HL7’s FHIR instead of applying resources against it, and indeed it was named the "hottest topic at HIMSS16" by HealthcareIT News. This means it is likely to stay in a “hype” cycle for a while.
HL7 Payer Summit and Connectathon
Despite the hype, there is progress. Less than year after I started my research on HL7 and FHIR, I had the opportunity to present at 2016 HL7 Payer Summit in Orlando. During this presentation, I showed a proof of concept developed by NaviNet Open’s research team that used FHIR for a payer authorization workflow. That same week, the same team joined Josh’s Mandel’s CDS Hooks work-stream at the January HL7 Connectathon. As a result of both these hands-on experiences, I can report that my cynicism for FHIR was misplaced. While FHIR has work to do, especially to get more folks actively engaged to vet emerging resources, I am incredibly excited that NaviNet, as part of NantHealth, has supported early adoption of FHIR to solve real world problems for our payer customers.
In digging around the edges of FHIR, interviewing people actually doing work on the emerging standards, using the nascent Resources and Extensions, and even taking a dive into the details with a few workgroups at HL7, I can share the following realities:
- There is real work being done to make interoperability better. The use of modern REST based APIs make it accessible to even healthcare newcomers.
- FHIR is a work in progress and very bright people are moving the standard forward daily, but they need help across the board. Implementers can impact and drive the direction in their respective expert area.
- The industry needs you, the people paying for care, at the table to ensure resource definitions can operate with both existing fee for service and emerging value based solutions in mind. Real, specific use cases are working and the emerging standard is being developed with these use cases in mind, so resources are specific and slimmed down, not complex and bloated.
- There are roles for both FHIR and the maturing CDA profile work. It is not an either/or decision.
Staying Updated on HL7 on FHIR
With all this exciting work, the reality is that the varying maturity levels and change underway across providers, payer, Standard Development Organizations (SDOs) and vendors will require that all parties support exist in a transient state for years to come. We, as payers and vendors, need to be prepared to meet provider organizations where they are, to provide helping hands, and to offer translation and abstraction layers for the end user. As progress continues, there are three key ways to stay up-to-date and get involved with HL7 on FHIR:
- Learn: Payers can be take advantage of three key areas:
- See: View demos, including NaviNet Open’s. Talk to us about FHIR and contact your other vendors.
- Do: HL7 pairs FHIR Connectathons with their workgroup meetings. The next meeting is in Montreal in May, or just dive in directly using resources on HL7 site and their wiki.