While the FHIR specification continues gaining momentum, early success stories are happening among hospitals around the country.
Health Sciences South Carolina, for instance, built a FHIR-based clinical data repository infrastructure to create an inter-institutional culture of collaboration for learning from clinical practice, and empowering action through access to data while advancing evidence.
"Our goal was to create the infrastructure for collaborative quality improvement across health systems and for technology-enabled communities of practice that advance healthcare collaboratively," said Jeff Jacobs, a data architect at Health Sciences South Carolina. "The specific problem that we were trying to address is the lack of a standard data model across institutions to support collaborative work."
FHIR, which stands for Fast Healthcare Interoperability Resources, is an emerging standard from HL7 that allows open access to clinical data without the requirement of proprietary or licensed programming infrastructure.
"We chose FHIR because of its potential use in supporting 'write once/run everywhere' apps to drive projects," said Leslie Lenert, MD, vice president and chief medical officer at Health Sciences South Carolina. "It allows us to tackle interoperability projects one resource at a time."
This architecture moves the organization from an information-at-rest model to one of information-in-motion, added Kenneth Deans, president and CEO of Health Sciences South Carolina.
In this architecture, each facility is able to have a dedicated repository of clinical data which is populated in real time based on feeds from various hospital EHR systems. Hospital data is normalized into FHIR Patient, Encounter, Condition, Observation and other resources. This data infrastructure is then combined with an enterprise master patient index to provide standardized research data reporting, and to enable SMART on FHIR based apps with a longitudinal view of data across institutions.
The repository is a mirror of the content of health systems' EHRs and other information systems that allows Health Sciences to create clinical and research programs that offer value for its members based on technology from Simpatico Intelligent Systems and Oracle.
"It provides an interactive data store in FHIR format that members can use for FHIR app development and to support patient access to their health data," Lenert explained.
"The feature of the FHIR repository that is most compelling to us is its support of FHIR subscriptions," Lenert added, "both for enriching the data of our members from external sources – such as mortality data and social determinants data – and its use in transforming that data into multiple different formats for collaborations; for example, Observational Health Data Sciences and Informatics for analytics and National Patient-Centered Clinical Research Network for research."
Broadly, the FHIR repository helps Health Sciences preserve the independence of multi-institutional data while simultaneously supporting the ability to link across institutions, Deans added.
Working with the FHIR repository is an enterprise master patient index from Oracle. The eMPI generates a unique, cross-system patient identifier for research and quality studies that allows easy linkage of data across sites. This identifier is integrated into member data repositories via the FHIR subscription mechanism. In addition to linkages of records, there are potential applications for collaborative maintenance of patient contact information across the network.
Bringing everything together, Health Sciences is just getting started. One of the prototype FHIR apps that Health Sciences created is a notification system for admissions to hospitals or emergency departments. Health Sciences also created an app that can present merged records across health systems.
An app might support collaborative work on avoidance of opiate dependence after surgery or diabetes management, Deans explained. A single app, in this framework, scan span multiple institutions, reducing costs and making advanced projects more feasible and easier to disseminate.
"Future apps will be more sophisticated and use the SMART on FHIR approach for EHR integration," Deans said. "Apps would support areas for collaborative quality improvement in technology-enhanced communities of practice. The idea is that a group of our members would work together to create an app and share experience on deployment and optimization in the community of practice."
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