7 March 2019

FHIR likely to become mandated in the US


The major government funding bodies for Healthcare in the US, the Centers for Medicare and Medicaid Service (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), have proposed a new set of rules which would imbed FHIR into all provider institutions and vendor products as a path to faster and more effective interoperability in the country.

Whilst CMS’s 251page policy aims to move the healthcare ecosystem towards interoperability, identifying Fast Healthcare Interoperability Resources (FHIR) as the means to do this, ONC’s 724page legislation focuses on defining data blocking.

Together these new policy changes mean a greater governing of interoperability, health data blocking, and the use of API’s with FHIR as the new required standard for development.

The intention of the US government  is to give data back to the patients, empowering the patient, at zero cost. Seema Verma, administrator of CMS, told the recent HIMMS conference in Orlando Florida when announcing the proposed new rules that  “The idea that patient data belongs to providers or vendors is an epic misunderstanding. Patient data belongs to patients.”

In Australia, the My Health Record (MHR) initiative has as a key goal empowering patients and institutions for free through better shared medical data. The US decision, if it proceeds, would mark a major change  in how the US  handles interoperability versus Australia.

Mandated FHIR, in an ideal world, would technically enable all institutions to talk to each other, and to patients via their devices, especially now that Apple has incorporated FHIR into the heart of its iphone operating systems. The MHR on the other hand is a centrally held record by the government, whereby individual institutions and providers have to agree to upload data on their patients, and patients need to agree as well. And so far, much of the data being stored is not easily accessible in the formats that it is uploaded and stored.

Although FHIR has been previously adopted on a voluntary basis in the US, with no regulations for compliance providers and institutions started to exploit the system, mainly by creating false obstacles to share data, in order to either retain patients within one provider system, or in the case of vendors, to restrict sharing between institutions in order to try to coerce the use of certain vendor technologies.

Varma told the Orlando HIMMS conference that the new regulations will see “Information blocking (become) a thing of the past.”

CMS believes that these new policies will have a flow on effect on the industry, leading to great leaps forward in development and creating a more progressive healthcare ecosystem.

“Freeing data from locked silos will spur innovation at a pace we’ve never seen before, supporting future advancements in healthcare through new medications, devices, and more personalised healthcare,” said Verma.

However, Governor Aneesh Chopra, former US Chief Technology Officer, pointed  out that these laws also hold a greater purpose – being a call to action for the private healthcare systems in America to lift their game.

 “The government has been behind the private sector in moving this forward; the private sector is now behind the government. We need to step up and we need to move forward. We need to take this opportunity to adapt and to improve and to refine,” he said.

FHIR founder, Grahame Grieve told Wild Health from the US that the new rules are a “big deal”, as it will likely mean that FHIR will become mandatory compliance for vendors.

However, he said the changeover would not without its challenges as FHIR, once a community passion initiative, will go from working with voluntary people who believe in the project, to a series of regulators, vendors and institutions being involved, most with some conflict, and most with some axes to grind on being forced to compliance, at least in a short period of time.

Grieve says that the US endorsement of FHIR will further increase the pressure on Australia to review its ongoing strategy with regards to distributing clinical information in order to better serve our healthcare system, and vendors, regulators and professional societies should take note.

However, Grieve is pessimistic we will see change in local policy anytime soon, believing the Australian government will probably want to wait to see the results in the US, before implementing any substantive changes locally.

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