FHIR ignites visions of a health app ecosystem

​A major standards upgrade will boost access to health information. It could even support ambitious plans for an app store for the health sector.
Written by Rob O'Neill, Contributor

A new health information standard is promising to speed application development and interoperability, and boost information sharing in the sector, especially on mobile platforms.

It could even support visions of an "app store" for the health sector.

FHIR, standing for Fast Health Interoperability Resources and pronounced "fire", builds on version three of the HL7 standard. However, it also uses ideas from organisations such as openEHR or IHE.

Crucially, though, FHIR adopts W3C's REST architecture, facilitating the development of scalable web services.

Multiple organisations and efforts are coalescing to support FHIR, said David Hay, a product strategist at health software developer Orion Health, member of the FHIR management group and chair of HL7 in New Zealand.

"Far from there being a standards war, we are actually seeing standardisation," he said.

FHIR is built around the units called "resources", the basic unit of interoperability, or, as Hay wrote in a blog post, "the smallest 'thing' that it makes sense to talk about". In health, these could include a patient, condition, or practitioner.

Hay said he expects FHIR developments to feature prominently at the HIMSS15 (Health Information and Management Systems Society) conference in Chicago in April.

"FHIR covers the format of information and how data is exchanged, so it is both an API and a model," he said.

It promises to make health information easily and securely accessed from any device, anywhere, he said. It is also focused on implementers, is straightforward to use, and has a community aspect.

Historically, Hay said, the HL7 standard had been closed since it was first released in 1987. In contrast, FHIR was open source from the beginning.

The healthcare sector has always considered its information special because of its sensitivity, he said, but that does not mean it should be unavailable.

"The ethos that 'special' equals 'different' is not true, The technology for exchanging health information is no different from anything else -- like internet banking."

For now, FHIR is a draft standard for trial use (DSTU). It's in DSTU1 now and DSTU2 is expected in June. Hay said it is expected to be "normative" in a couple of years.

As for Orion Health, it is already involved. Hay said the advantages of getting in early are that a company like Orion can use the IP and influence the development of the standard. There is a first mover advantage there.

It's important, too, because Orion is an aggregator of health data and shifts between systems through its Rhapsody integration engine and open platform, the company's Cassandra-based data store.

The downside is being on the bleeding edge. What is standard today will be different in six months' time.

"You have to build for that variability," Hay said.

FHIR will help break down, or rather break open, information silos. Not doing so, Hay said, is "incredibly dangerous".

A lack of readily available patient health history, for instance, often forces professionals in areas such as accident and emergency departments to make guesses about appropriate medication when there is no one to speak for the patient.

FHIR could allow access to such vital data at the push of a mobile app button.

It could even support the so far elusive vision of a health sector "app store" of independently developed mobile applications. Because it supports the collection of data and availability via APIs, it will be freely available to smaller vendors, Hay said.

"FHIR absolutely does that."

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