By Nick White, Brian Dorricott, Paul Deffley and Vivek Krishnan
75% of healthcare executives rank data interoperability as the highest or one of the highest priorities for their organisation, according to industry leaders in a 2022 Google Cloud and Fierce Healthcare survey.
Interoperability has been a persistent challenge due to the complexity of technical, regulatory, and cultural factors that are deeply ingrained in the healthcare industry. Various tools such as FHIR, HIE, HL7 and NRT have been developed over the years to address interoperability issues, however for care workers, decision makers, and executives, it can be challenging to stay abreast of it all. This is especially true in an environment where healthcare demand is growing and associated technology is changing rapidly.
In this article we tackle questions such as:
- What is FHIR?
- What is a FHIR Events Platform?
- How does a HIE differ from FHIR?
- And why should I care?
What is FHIR?
Before we get into the definitions and semantics of FHIR, let’s take a moment to imagine a world where a common language, such as English, did not exist. Picture the challenges that would follow when it comes to travel, trade, and conducting business across geographical boundaries. As society has evolved, the importance of having a common medium for communication was recognised. This is precisely what FHIR seeks to achieve in healthcare.
FHIR is essentially a set of standards for exchanging healthcare information electronically. It defines a standardised data structure centred around healthcare workflow and formats such as HTTP and JSON to facilitate communication across modern devices.
A typical healthcare organisation deploys and uses systems such as a Patient Administration System, Medication Management System, Electronic Medical Record, Radiology and Laboratory Record and other specialist systems. FHIR allows these systems to communicate with each other using an agreed and published vocabulary.
In terms of who owns and maintains FHIR, its development and maintenance is a community-driven approach , however it is actively managed by HL7 International. HL7 FHIR has an active and engaged community of healthcare professionals, developers, organisations, and stakeholders who contribute to its development, enhancement, and adoption.
FHIR, originating in Australia in 2011, provides an extensible communication language and, in a few short years, was adopted in the 2016 21st Century Cures Act in the USA. Two key things happened as a result of the $500 million investment by Congress in healthcare:
1. The FHIR standard was adopted for transmission of medical information; and,
2. From 2021, it became illegal to prevent patients having access to their medical histories.
As a result of these two decisions, adoption of FHIR in the USA Healthcare system (and, by extension, the rest of the world) exploded. In fact, FHIR has been recognised as the standard for health data exchange in the NHS in the UK, and in Australia’s recently launched FHIR accelerator program.
Over the last few years, vendors of legacy Electronic Health Record Systems (EHRs) have been scrambling to add FHIR capability to their systems to comply with the legislative requirements. If adding the ability to allow third parties to “read” medical data through FHIR has been challenging for these organisations, it is nothing to the complexity of allowing third-party applications the ability to write medical information back into patients’ health records.
This is why you are unlikely to see the heart rate information recorded by your digital watch appear in your hospital patient record any time soon. The traditional underlying technology is too inflexible to support the rapid advancements of new medical devices in a scalable way.
The good news is that FHIR has exactly the flexibility that traditional healthcare information systems don’t have. Its design principle of allowing a flexible approach to storing and transmitting medical information means that any platform with FHIR at its core can manage all future medical advances.
What is a FHIR Events Platform?
A conventional architecture for a system includes a database, an application server and an integration engine or a business layer to exchange data. The focus is on storing, retrieval and manipulation. Although the database technology has become sophisticated, one of the challenges database driven architecture still faces is the latency as the operations are synchronous in nature i.e. a request is made and the system waits for a response before proceeding with next action.
On the other hand, in an event-driven platform, the focus is on reacting to and handling specific events. This approach is well-suited for applications that need to respond promptly to changes in the environment or user input. The main advantage of event-driven architecture is that operations are asynchronous in nature, meaning communication can occur individually.
A FHIR events platform is a software system designed to facilitate the exchange of healthcare-related events between different systems using the FHIR standard. It enables real-time data synchronisation, notifications, and workflows.
Let’s demonstrate this with some practical examples:
An event in healthcare could be an INR result from pathology, a blood glucose reading from a continuous glucose monitor or even a submission to Medicare for a chargeable item.
A FHIR Events Platform processes and manages digital records for these healthcare events and can trigger other actions such as alerts or notifications, in real time. It can trigger actions or workflows based on specific FHIR data events, such as alerting you about critical changes in a patient’s condition, or the change in status of those test results for which you have been waiting. In the example of the INR event, a high INR can trigger a workflow to recommend you stop blood thinning medication to reduce the risk of bleeding during surgery. It supports applications such as remote patient monitoring, real-time decision support, care coordination, and other applications requiring immediate access to healthcare data.
FHIR events platforms are designed to handle high volumes of healthcare data efficiently and integrate it with other healthcare systems, medical devices, or applications in real time.
However, it is worth being aware that many healthcare organisations continue to face a significant challenge in that several of the applications they have deployed were built prior to the widespread adoption of the FHIR standard, so there remains a large installed base of legacy applications and older instances of systems that don’t yet natively support the FHIR standard.
Leading FHIR Events Platforms cater to these needs by providing integration capabilities for legacy health IT systems that don’t have a FHIR API, and they then map this data into the FHIR standard. These advanced solutions enable healthcare providers to maximise the investment in their existing suite of applications, minimising the change impact on the workforce whilst liberating their data and making it accessible for both new IT acquisitions and advanced analytics.
It is worth recognising that a FHIR Events Platform is different to a FHIR Server. A FHIR Server is commonly used as a central repository for an electronic health record (EHRs), a health information exchange (HIE), or other healthcare databases. The FHIR Server stores the data in a FHIR format and makes it accessible to healthcare applications and systems, however it does not facilitate real-time triggers for workflows and actions based on event triggers.
So, if a FHIR Events Platform facilitates the exchange of healthcare data between IT systems in real-time using the FHIR format, is it a form of a Health Information Exchange (HIE)?
To answer this, let’s look at the definition of a Health Information Exchange (HIE).
A HIE is a system or network that enables the exchange of health information between different healthcare organisations, such as hospitals, clinics, laboratories, and more. HIEs can handle a wide range of healthcare data formats and standards including FHIR, facilitating the exchange of historical patient data across organisations, regions, states, or in some cases between countries as is being done in the European Union.
While a HIE is used to facilitate the exchange of health information between organisations, a FHIR Events Platform is a new generation architecture to process and manage real time exchange of health data using the FHIR data standard. To draw a simple analogy, HIE is similar to the Post Office and a postman whose job is to deliver letters and parcels. In contrast, a FHIR Events platform is like a sophisticated processing centre equipped with supply chain robotics and processes designed to enable delivery of communications in real time, in a standard format that can be read by other systems.
By this definition, a FHIR Events Platform is not a form of a HIE, and a HIE plays a very different role from a FHIR Events platform and is more aligned towards a FHIR server.
Both have crucial roles in the future of an interoperable health data landscape, however, they are deployed at fundamentally different levels of the healthcare landscape.
So when would you choose to invest in a FHIR Events Platform?
- Strengthen Health IT Investments:
- A FHIR Events Platform can integrate with your existing applications and provide access to the data in FHIR standard for cost effective integration across your application landscape and enable adoption of new FHIR based solutions.
- Simplicity and Speed:
- FHIR events platforms can be simpler and faster to implement than traditional application integration, especially if your primary focus is on FHIR-based data exchange.
- Real-Time or Near-Real-Time Data Exchange:
- If your use case involves real-time or near-real-time data exchange, such as patient monitoring, alerts, or event-driven healthcare applications, a FHIR events platform may be suitable. A FHIR Events Platform is optimised for real-time data updates.
- Driving Value from Data into New Solutions:
- New developments in healthcare applications can revolutionise care delivery, with the incorporation of AI technologies, highly configurable and engaging user interfaces, and tailored workflows which closely mimic clinical workflow. However, these solutions typically require access to data from existing assets, preventing adoption. The FHIR Events Platform solves this challenge.
When would you chose an HIE?
- Comprehensive Data Exchange is Required:
- If your goal is to exchange a wide range of healthcare data, including various data formats and standards, across multiple healthcare organisations or regions, an HIE may be the appropriate choice. HIEs are designed for broad interoperability.
- Interoperability Across Different Standards:
- HIEs can facilitate data exchange using various healthcare data standards, including HL7, CDA, and FHIR. If you need to work with different standards, a HIE can act as a bridge.
- Complex Governance and Policy Requirements:
- If your objective involves complex governance, data security, and privacy requirements, a HIE may be suited to handle these challenges. HIEs often have established governance models.
- Historical Data Exchange:
- HIEs can exchange historical patient data, which is important for comprehensive patient care.
With all this in mind, is Miya Precision a FHIR Events Platform or an HIE?
Underpinning Miya Precision is a FHIR events platform that has been built from the ground up to standardise and store data in a FHIR format, facilitate clinical workflows, and enable real-time exchange of data. It was developed in Australia and provides the capability to draw real time data from legacy systems not compatible with FHIR, maps that data onto the FHIR standard, and makes it available as a FHIR resource to applications connected to the Miya Precision platform. This enables real-time integration with FHIR and non-FHIR resources and allows organisations to harness the power of their digital ecosystem. The platform has been expanded and is now used by healthcare organisations in multiple regions beyond Australia. Numerous leading healthcare organisations have implemented Miya Precision to enable them to draw extensive value from existing applications, the data on those systems, and the new generation of applications that sit on top of the FHIR Events Platform.