FHIR Adoption and Implementation Challenges

Kishore Pendyala, CEO of KP-Tech Services

The Fast Healthcare Interoperability Resources (FHIR) standard was introduced by HL7 in 2014 as a significant replacement for the HL7 V2 and V3 standards. An open standard called FHIR, which was initially drafted in 2011, makes it easier than ever for legacy systems and new apps to exchange data. FHIR was created to not only increase communication efficiency and interoperability compared to earlier standards, but also to facilitate implementation by giving clear specifications and allowing developers to take advantage of popular Web tools. 

FHIR vs HL7 

The fundamental distinction between HL7 and FHIR is that HL7 only supports XML, whereas FHIR makes use of RESTful web services and open web technologies like XML, JSON, and RDF. Building on earlier standards like HL7 CDA, V2, and V3, FHIR is more user-friendly because it supports a wider range of technologies. 

Additionally, FHIR offers a variety of alternatives for data exchange between systems. It supports the RESTful API strategy, which substitutes one-to-many interfaces with point-to-point interfaces. Data exchange proceeds more efficiently as a result, and it takes less time to new data exchange partners. The earlier HL7 standards are less flexible and more out-of-date in this regard. 

How FHIR is replacing HL7  

The healthcare FHIR standard is capable of everything HL7 V2 is and more. It features a less challenging learning curve and does away with HL7’s restrictions. 

Advantages of FHIR over HL7 

– Unlike HL7V2, FHIR is not constrained to a specific encoding syntax. 

– Additionally, it speeds up implementation, provides strong security features, and supports one-to-many data sharing. 

– The meaningful pieces that is shared or exchanged as “resources” (which are somewhat comparable to “segments” in HL7 V2 messages). A resource may contain text, metadata, or bundled groups of data that together make up clinical documentation. Similar to a URL for a web page, every resource has an own identification tag. Devices and apps can easily obtain necessary data through that tag without going through laborious data exchange procedures. Resources can be changed and deleted using the RESTful API strategy. 

– Mobile apps are especially suited to FHIR. FHIR enables APIs to obtain the necessary data from many systems and give it in forms that programmers can quickly include into their mobile applications. And because only the requested data is communicated via FHIR, that data can be shared quickly, which is essential for mobile apps. 

– The use of FHIR for mobile healthcare apps has clearly gained traction. The SMART on FHIR API was developed in 2014 by the SMART (Substitutable Medical Apps, Reusable Technologies) Health IT project to give developers the ability to create apps once and use them throughout the healthcare system. Additionally, Apple developed an FHIR-based health records feature for its iOS operating system in 2018, providing customers with convenient access to a variety of healthcare data. 

– Version FHIR-R4: FHIR R4 was made available in January 2019. The initial normative content for the interoperability standard is contained in HL7 FHIR R4, providing a solid foundation for the healthcare IT sector. 

– FHIR R4 served as a normative standard to indicate that particular resource types within the FHIR architecture had attained stability. In order to achieve normative status, one must adhere to HL7’s version management strategy and attempt to maintain forward compatibility with future releases (the standards organization overseeing FHIR). 

– FHIR Works on AWS is a new AWS Solutions Implementation with an open-source software toolkit that can be used to develop an interface for existing healthcare apps and data using Fast Healthcare Interoperability Resources (FHIR). FHIR APIs that support the standard are provided via a serverless implementation. 

Why Adopt FHIR? 

Information sharing may be made easier, implementation is made simpler, and mobile apps are supported better thanks to FHIR. Additionally, it provides crucial use cases that are advantageous to patients, payers, and providers. 

To hasten decision-making, clinicians can exchange patient data more effectively among teams. Clinical data can be added to claims data by insurance companies to enhance risk assessment, reduce costs, and enhance outcomes. Additionally, patients can have more influence over their health by getting access to medical data via user-friendly apps that operate on smartphones, tablets, and wearables. 

These are all excellent arguments in favor of implementing FHIR. However, many businesses have no other option. The U.S. Centers for Medicare & Medicaid Services (CMS) finalized a requirement for the use of FHIR by a range of payers and providers subject to CMS regulation starting in mid-2021 in 2020. 

This year’s ONC Cures Act Final Rule mandates that qualified health IT developers update and offer their clients certified API technology— FHIR-based application programming interfaces—by December 31, 2022.

FHIR Implementation Challenges 

FHIR-compliant systems take time and resources 

Systems that are FHIR compatible need effort and time. 

The process of implementing FHIR is not very simple. From foundational to structural interoperability, the approach involves multiple steps. You must fulfil inter-connectivity requirements in each app utilized in order for FHIR-compliant systems to be fundamentally interoperable. Applications must safely communicate and exchange data. The structural aspects of organizational interoperability must be altered. Communication between companies, entities, and individuals, as well as every end-user process, must be integrated. 

Simply said, thorough study of the present system is necessary for FHIR implementation. Your current systems require investment in high-quality research if you want to enhance them. Resources are strained, but it contributes to the development of FHIR healthcare services with the maximum level of interoperability. 

FHIR integration are tailored to specific business needs 

Business objectives are pursued by FHIR-compliant systems in addition to technical optimization. Therefore, effective business analysts are needed for FHIR implementations. Particularly for TPAs in the healthcare industry. Traditional healthcare providers have similar needs, but third parties have their own business models and applications for healthcare data. For instance, they could need to combine insurance information with patient medical records in a single system. Therefore, before developing data infrastructure, a technology partner that provides a data exchange system for such an organization must investigate its business logic and data formats. It results in more difficulties with HL7 FHIR integration services. 

Issues with FHIR security are inevitable. 

FHIR will force a business to reevaluate some security procedures, even if it complies with HIPAA regulations and safeguards patient data. The issue is that sharing access to some system data is a need when implementing FHIR healthcare services. It makes people more vulnerable and presents new security difficulties. Interoperability presents concerns about how to map data while upholding the same level of confidentiality for transferred data as with other PHI. There is a demand for multi-tenant models with extensive use functions, roles, and permissions. Better data control is provided, but configuration is more challenging. 

 Lack of technical expertise 

Healthcare vendors and TPAs require either qualified internal specialists or outside assistance to embrace FHIR services. Since HL7 FHIR services are a relatively new standard, there aren’t many people that are familiar with setting up FHIR cloud platforms. Therefore, there will be a lack of engineers who are knowledgeable of the FHIR API. The number of healthcare organizations working to comply with FHIR regulations is growing, and there is a huge need for experts in FHIR APIs. 

This is why it could be difficult to find someone to implement FHIR services. The majority of healthcare organizations think about using an outside vendor to get around it. A software development company with relevant knowledge may quickly and affordably produce customized open-source solutions that adhere to FHIR specifications. 

 Data uniformity in third-party applications 

Setting up the functionality of the FHIR APIs requires data manageability and consistency. The records must match and be in the same format across any connected third-party software. You won’t be able to use cloud FHIR systems interchangeably until then. Building a system with reliable data or transferring Epic to the cloud are considerably more difficult than they appear. In addition to other tasks, you’ll need to identify potential data problems, create processing rules, specify compliance metrics, and use data remediation processes. Additionally, you should read How to Integrate an EHR System Like Epic, Cerner or MEDHost, Carecloud, Pelitas. 

 A never-ending saga is the FHIR integration process. 

The complexity of healthcare systems will only increase in the future. Furthermore, not all systems are compatible with the FHIR standard. To ensure FHIR security and be HIPAA-compliant, data sharing procedures should be evaluated in connected third-party apps. 

So, the best course of action could be to work with a seasoned FHIR provider. They’ll aid in the adoption of new features while maintaining compliance by offering continuing support. 

Preparing for FHIR adoption 

Significant system changes may be necessary to support FHIR. The standard also imposes several stringent guidelines that are difficult to implement without an appropriate plan. 

In order to deploy FHIR services and adhere to the best practices in the industry, it is crucial to create a clear roadmap. The analysis is required to determine how FHIR resources will address specific technological or administrative issues and create the necessary documentation. 

About Kishore Pendyala

Kishore Pendyala has more than 20 years of experience in the Healthcare IT domain. He prides himself on understanding the complexities of enterprise business as well as the intricacies of running a small company. He has worn many hats (often at the same time) throughout his career including data analyst, product owner, business analyst, software engineer, team leader, QA engineer, and probably several others. Out of all of this, he’s discovered his passion is really in identifying simple and effective solutions to Healthcare Interoperability issues. This has driven his leadership at KP-Tech Services as CEO and co-founder and has proven to be sustainable, and productive for the company.