How FHIR Data Standard Implementation Enhances Interoperability

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Posted on December 6, 2021 by Hannah Nelson

University of Pittsburgh Medical Center (UPMC) has adopted the FHIR data standard to enhance interoperability and intraoperability at the organization.

As healthcare organizations look to enhance their interoperability efforts and comply with ONC information blocking regulations, many stakeholders are adopting application programming interfaces (API) that leverage the HL7 Fast Healthcare Interoperability Resources (FHIR) data standard.

Kristian Feterik, medical director of interoperability and clinical associate professor of medicine at University of Pittsburgh Medical Center (UPMC), noted that while implementing FHIR is no small feat, widespread adoption of the standard will help advance data sharing nationwide.

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“Given the customized nature of each electronic health record, we believe that implementation of FHIR will be a heavy lift, especially when we’re thinking about well-functioning, well-oiled interfaces,” he explained. “We believe that it is a worthwhile exercise and that all healthcare will have to participate in order to further advance and achieve the next goal of interoperability.”

Feterik noted that, in essence, FHIR is a simple concept.

“It is a transport layer. Basically, the key concepts in FHIR are modular and they have an interconnecting structure,” Feterik said. “However, what happens is that there are often guidelines—not so much standards—that are set.”

For example, he noted that there are 10 to 50 properties for each FHIR resource, such as patient demographic information or medication orders. However, EHR vendors select only some of those resource properties to be required, as opposed to making all of them required. This ultimately hinders data-sharing efforts, as the data standard is not implemented in a uniform way across the care continuum.

“If we are to achieve better interoperability, we really would need to agree upon the required properties or attributes of a resource so that when those properties are missing, we could establish a better way to exchange information,” Feterik emphasized.

Feterik noted that there have been nuances for each healthcare system in complying with the ONC information blocking rule. However, he added that, with almost two decades of interoperability experience, UPMC appears to be well-positioned in the interoperability arena.

Additionally, Feterik spoke on the importance of intraoperability, which refers to the streamlined exchange of data within an organization.

“We have been working on robust HL7 connections between our ambulatory electronic health record, which is on Epic, and our hospital-based electronic health record, which is on Cerner,” Feterik explained.

These HL7 connections have helped streamline care coordination, he said.

“Our providers are able to quickly see the instance of ambulatory appointments at the same time that they have the inpatient visits open,” Feterik noted. “This differentiation is powerful because it is leveraging best-of-breed applications for both ambulatory and inpatient.”

Although the amount of data coming at end-users can be overwhelming, Feterik expressed confidence that users would grow more accustomed to navigating EHRs as interoperability and intraoperability become more prevalent.