HL7 Preps Healthcare Clinical Messaging Standard

7 Big Data Solutions Try To Reshape Healthcare

Health IT standards-development organization HL7 has developed a new standards framework for clinical messaging. Known as Fast Health Interoperable Resources (FHIR), the new architecture could simplify the writing of interfaces between healthcare information systems. It could also provide a much-sought method for clinical research organizations to pull data out of electronic health records (EHRs).

The HL7 membership will vote in September on whether to accept FHIR as a draft standard for trial use. If enough organizations test it and find it feasible, HL7 could adopt FHIR as a "normative" standard by the end of 2014.

According to an HL7 document, "FHIR solutions are built from a set of modular components called 'resources.' These resources can easily be assembled into working systems that solve real world clinical and administrative problems at a fraction of the price of existing alternatives... FHIR has resources for administrative concepts such as patient, provider, organization and device as well as a wide variety of clinical concepts covering problems, medications, care plans, financial concerns and more."

In an interview with InformationWeek Healthcare, Charles Jaffe, MD, CEO, of HL7, explained that these "resources" take the place of the traditional elements in HL7 messages. If new elements are desired, they can be created in an hour or two, he said, and can be quickly validated for interoperability. In contrast, he noted, the process for adding new components to HL7 messages currently can take weeks or longer, "because the [HL7] balloting process needs to establish that the specification you've developed is reliable and achieves the end result you want."

[ Learn more about why interoperability is gaining supporters. Read Why Telemedicine Should Be Integrated With EHRs, ACOs. ]

FHIR also addresses two other problems that healthcare organizations have had in using HL7's current messaging standard. First, hospitals often customize the messages by adding "extensions" to messages to accommodate their own needs. When they send these messages from one information system to another, they're human readable, but the receiving system may not be able to understand the messages. FHIR solves that problem by "defining a simple framework for extending and adapting the existing resources," the HL7 document says.

"In FHIR, the resources approach development in a way that the ambiguity doesn't interfere with the interpretation by another recipient," Jaffe explained. "You can message back and forth and not have the ambiguity." The messages also remain human readable, he added.

Second, every time a healthcare organization changes one system, it must rewrite HL7 interfaces to all of its other systems. This can cost a large, multi-hospital organization millions of dollars a year, Jaffe noted. "FHIR will change that paradigm of interface development. It will be easier and far less expensive," he said.

According to Jaffe, FHIR is compatible with all of the document templates in HL7's Clinical Data Architecture (CDA). That includes the Continuity of Care Document (CCD) that's built into some EHRs and the Consolidated CDA that must be used for the care summaries that have to be exchanged during transitions of care in Meaningful Use stage 2. Because both FHIR and CDA are based on HL7's Reference Information Model, Jaffe views the two architectures as complementary. Users should be able to move seamlessly back and forth between FHIR and CDA templates, he said.

"They not only can live together, but they'll enhance one another because of the ability to choose what's best for the circumstances," he said.

FHIR is also compatible with a wide variety of data transport mechanisms, including SOAP and RESTful. The latter is a Web API that allows looser coupling of Web services than SOAP does.

In addition, Jaffe noted, FHIR can be used to create other kinds of communication protocols. For example, he said, "You can put some of the HL7 specs in the read-only memory of a cellphone, so you don't have to transmit all of a message -- which might demand a lot of bandwidth -- each time you send the message from one device to another."

FHIR also provides a major opportunity to connect clinical care and medical research, he said. "Right now, the clinical research industry has a very hard time getting data out of EHRs. That will become orders of magnitude easier in this environment."

Conversely, if FHIR were applied to a "learning health system," he added, that might lead to faster transfer of new discoveries to patient care.