Welcome to 2016. Let’s jump right into the FHIR! In the January 4 Acumen blog post Terry Ketchersid mentioned Fast Healthcare Interoperability Resources (FHIR) as a 2016 product to “keep your eye on.” Terry notes that many health information technology (HIT) experts think FHIR will prop open the door to interoperability and, much like a campaign Super PAC, FHIR is now supported by a “group of prominent private stakeholders.” In the blog this week we’ll lay the groundwork for keeping an eye on FHIR and the Argonaut Project.
The July 14, 2014, Acumen blog post highlighted a new report — “A Robust Health Data Infrastructure” — which defines U.S. national goals for HIT. This report documents the recommendations of a group of prominent scientists, the JASON group. Established in 1960, the 30-60 member group offers counsel to the government, especially the Office of the National Coordinator for HIT (ONCHIT), on science and technology issues. The JASON report identifies key areas of U.S. HIT shortcomings as follows:
- In general, Electronic Health Records (EHRs) and Health Information Exchanges (HIEs) are “woefully inadequate” in what they provide to healthcare professionals
- Data collection today is intrusive in the workflow
- The Meaningful Use (MU) interoperability requirements are inadequate
- Vendor proprietary issues are a barrier to progress
- There is no consensus on data standards
- Personal health records should be continuous, not episodic
Subsequently ONCHIT published “A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure,” which establishes building blocks to remediate HIT shortcomings identified in the JASON report. Central to the 10-year plan is standardization through the creation of a national HIT data “ecosystem” with interoperability and flexible data exchange.
FHIR was the main topic of the June 16, 2014, Acumen blog. HL7, the international IT data standards organization, created and sustains the ongoing development of FHIR. FHIR is an open source framework that manages data into standard packages that can be exchanged among disparate HIT systems. It replaces data exchange interfaces with effective interoperability for a key data subset.
The Argonaut Project
Chartered in December 2014 by a group of “highly motivated health information vendors and healthcare organizations” dedicated to accelerating HIT interoperability, the Argonaut Project continues to be supported by a group of private sector stakeholders committed to acting on the JASON report recommendations. The name JASON was coined in reference to the mythological Greek hero who embarked on a journey to bring the Golden Fleece back to the ancient Greek city of Lolcos. JASON is supported in his journey by the Argonauts, sailor and heroes on the ship, Argo. In our modern day IT story the JASON scientific group recommendations are being propelled into action by the Argonaut project sponsored by a group of prominent private sector stakeholders.
The Who’s Who of Argonaut sponsors includes:
- Beth Israel Deaconess Medical Center
- Intermountain Health
- Mayo Clinic
- Partners Healthcare System
- SMART at Boston Children’s Hospital Information Program
- The Advisory Board Company
This group has used financial and manpower resources to support HL7 development of FHIR standards. The goal is to create usable, secure avenues to access data from various sources through application programming interfaces (APIs). The Argonaut Project committee members work directly with HL7 FHIR teams to support efforts such as pilot testing and Connectathons, which help rapidly advance FHIR standard development.
The Argonaut Project group is aware that the aggressive ONCHIT agenda for HIT interoperability has led to discussion about EHR certification and Meaningful Use requiring the use of FHIR standards. The group has been transparent about publication of FHIR progress and requesting that ONCHIT delay such requirements until the standards are mature and fully tested.
Beth Israel Deaconess Medical Center Chief Information Officer, Dr. John Halamka, often includes Argonaut Project and FHIR updates in his geekdoctor blog. In December 2014 he outlined the FHIR objectives that will enable this set of query/response standards to support U.S. HIT interoperability. At that time an online Healthcare Informatics article noted that all stakeholders believe that MU Stage 3 will state that FHIR specifically should be used to enable flexible data exchange among independent HIT systems.
HL7 openly publishes about FHIR and their work. Among the online HL7 documents is an interesting Appendix on “The Role of Informatics in the Shift from Reactive to Proactive Healthcare.” This 2-page essay provides a glimpse of how informatics may disrupt the delivery of healthcare. The authors note that today gene sequencing is largely a computing science and not a chemical analysis. Also, pervasive sensing and mobile devices are providing continuous data that support personalized healthcare. This data supported by informatics will enable “non-experts” to play a bigger role in healthcare data management and decision making. Healthcare informatics can manage big data to anticipate and predict problems, making healthcare delivery less reactive and more proactive. If healthcare informatics is truly disruptive then this is what lies ahead:
“Digitization of biology and health will allow machines to help, lead to a demystification of disease, the democratization of healthcare, and a move from the treatment of disease to the promotion and maintenance of wellness.”
As an organized group of national scientific experts, JASON has set the course. The Argonaut Project stakeholders are in the boat pushing the rapid but responsible development of viable healthcare data interoperability, with FHIR as a public API. As a result, U.S. Healthcare Informatics may, yet, find the Golden Fleece.
Dugan Maddux, MD, FACP, is the Vice President for CKD Initiatives for FMC-NA. Before her foray into the business side of medicine, Dr. Maddux spent 18 years practicing nephrology in Danville, Virginia. During this time, she and her husband, Dr. Frank Maddux, developed a nephrology-focused Electronic Health Record. She and Frank also developed Voice Expeditions, which features the Nephrology Oral History project, a collection of interviews of the early dialysis pioneers.