The subcommittee, called the JASON report task force, composed a list of recommendations on how best to deal with the advice of a group of scientists called the JASON that HHS hired to get an arm's-length opinion on what direction to take on interoperability. They included using the Stage 3 meaningful-use criteria of the feds' EHR incentive payment program to leverage FHIR adoption.
FHIR, a project of Health Level Seven, a standards development organization specializing in healthcare IT, debuted this year at the Healthcare Information and Managements Systems Society's annual convention and has gained momentum since. FHIR uses application programming interfaces, or APIs, which the JASON scientists said would improve accessibility of clinical data for caregivers, researchers and patients.
Some healthcare IT leaders wholeheartedly endorse the recommendations on using APIs.
“I think it's a great idea,” said Dr. Thomas Payne, who chairs the task force on status and future direction of EHRs of the American Medical Informatics Association, and medical director of IT Services, University of Washington Medicine.
Despite EHR vendors having created “very complex and very detailed” health IT infrastructure, there are gaps in functionality, said Payne, speaking from personal experience. At UW, clinicians and programmers used APIs to create custom apps for signing out and to help physicians prepare for rounding.
“That's an example of what I see as a very exciting possibility” stemming from the JASON recommendation on APIs, Payne said.
Thousands of developers have used APIs to connect thousands of mobile apps to smart phones. Healthcare could similarly benefit from a broader group of people working to improve EHRs than vendors alone can provide, according to Payne.
Where would Payne like to see them begin?
“Personally, I would approach the problems that are more troublesome to physicians,” he said. “Physicians complain that they send too much time writing notes and entering data into the computer and less time listening and thinking. I would make I easier to create documentation and enter information into the patient's record without having to type and click on 16 different buttons.”
CHIME President and CEO Russell Branzell also supports the aims of the task force.
“The concept is good, (but) we've failed in a lot of concepts over the years,” Branzell said. “The real key is, will they be able to operationalize it.”
Nearly four years ago, the President's Council of Advisors on Science and Technology urged the healthcare industry to look to Web-technology to improve interoperability, but the recommendations were then deemed to be too much, too soon. Nothing much came of the PCAST recommendations.
Branzell said things are different now.
“We've been successful despite a clear standard, (but) we're not very sure we can move much farther without this kind of collaboration,” Branzell said.
But not everyone in the health IT community wants to jump aboard the speeding FHIR truck.
“We question the rush to judgment to anoint FHIR” for meaningful-use Stage 3, said Eric Heflin, chief technology officer at the national health information exchange, called eHealth Exchange, and the one for Texas, HIETexas.
Heflin spoke up during the public comment period at Wednesday's meeting and added words of caution later in an interview.
Rather than adopting an architecture on faith that it can be used to solve problems, Heflin advocates a more methodical approach, specifying “precise use cases” that involve specific, real world problems and then pilot testing the technology to see if it can solve those problems.
“It's easier to design on paper than in concrete,” Heflin said. “Many EMR and HIE products already have APIs based on open standards.” But many of those APIs were “not turned on” when their systems were installed and configured because “the purchasing party didn't know to ask for them.”
“If I could wave a magic wand, what I would feel is the best approach, the safest and the less costly approach, would be to fix the known issues and gaps in the APIs we have today, and then, parallel, see if other innovative approaches were actually viable,” Heflin said. “Let them get piloted out, and if those pilots meet additional needs, then let the industry adopt them.”
Dr. William Bria, president of the Association of Medical Directors of Information Systems said he's dubious that FHIR is the answer to the industry's interoperability conundrum.
“Premature closure that purports to solve one of the thorniest problems that confronts healthcare—good luck,” Bria said. “Any 'hail Mary' pass on interoperability that claims to be the answer, I'm very skeptical.”
Follow Joseph Conn on Twitter: @MHJConn
