The next generation of standards created by Health Level Seven (HL7) is FHIR®, which combines features from HL7®v2, HL7®v3 and CDA®. I was fortunate enough to have a conversation with Sally Love Connally, VP of Strategy and Business Development at McKesson, to learn more about McKesson’s perspective on FHIR and how they are currently using the new technology.
HealthIT & mHealth: How is McKesson currently utilizing FHIR?
Sally Love: We are extremely excited about the potential power and capabilities that FHIR offers. FHIR is still relatively new. McKesson is trying to accelerate the maturity of the standard so that it is commercially ready to meet the needs of our market. McKesson was one of the first stakeholders in Project Argonaut along with several other key stakeholders initiating the effort to really push FHIR forward. We recognized that FHIR combined with REST are essential components to achieve the level of person-centered interoperability required for the transition to value-based payments. Currently, we are actively working with Argonaut to progress the standard as well as with our internal teams to determine where the use of FHIR makes the best sense for us as a company. We are excited about its capabilities and see FHIR as a powerful tool for a variety of uses cases, including real-time clinical decision support (CDS), where sharing discrete data makes sense.
FHIR also enables SMART-based applications to personalize workflow and address some of the key provider challenges as they use EHRs. Overall, it is important for care coordination, and it is amazing how excited people can get about a standard, which is pretty rare in our industry. As with any standard, there will be growth challenges, and it’s best to begin using it—that’s the only way to learn its limits and where improvement is needed. McKesson is conducting a series of internal connectathons in which we are building on the strength of our FHIR experiences and expanding our knowledge of the power and the strength of the standard. Our people are seeing that FHIR is easy to learn and has a lot of practical applications for our solutions.
HealthIT & mHealth: Do you currently have any clients that use FHIR?
Love: We have not rolled FHIR out in a production state at this point. Our RelayHealth business is the service provider for CommonWell Health Alliance and its RESTful services were inspired by early drafts of FHIR. At this point, other McKesson businesses are looking at it for the next stage of our applications and solutions. We are in the process of talking to customers who are interested in working with us on various use cases and proofs of concept.
HealthIT & mHealth: Will clients who are currently using the CDA architecture switch over to FHIR completely or use both FHIR and CDA architecture for different processes?
Love: We see FHIR as a complement to the CDA. I believe there will continue to be a place for the CDA in our market; full document exchange is going to remain important. However, FHIR will be used more frequently in the granular exchange of information for use cases where there is no need to move the entire document.
HealthIT & mHealth: What types of projects are you doing with the Argonaut Group?
Love: We are currently working on profile mapping. In fact, most or all of the vendors are focused on profile mapping and looking at the common clinical data set. Argonaut is focused on the original Meaningful Use Stage 2 (MU2) data set. With the Stage 3 NPRM coming out, the common clinical data set has been expanded, so we are reconciling that. Argonaut has just kicked off phase 2 with significant focus on implementation to continue to improve on the quality of the specifications and ultimately the implementation guide.
At HIMSS, we did a demonstration with our Paragon® electronic health record at the CommonWell Health Alliance booth. We demonstrated FHIR with Cerner and Athenahealth, sharing medication information in a variety of care delivery scenarios that involved all three vendors. It was a compelling example of what FHIR can do. We used the CommonWell Health Alliance® broker to fan out across the systems looking for a common patient and then pull the medication information from each site that the sample patient had visited and present it to the provider. This exchange could be used by a care coordinator to update a shared plan of care, or it could be used by a provider at a point of service to understand the patient’s current medications. The real-time exchange of information is use case-specific so you don’t have to go through the entire summary of care information. Instead you can immediately access the medication information, which is what the provider would need at that point in time.
HealthIT & mHealth: How many clients do you think will be using FHIR in the next two to three years?
Love: We will begin to introduce FHIR-based services gradually. As we move toward the 2015 edition of certification for HIT and see Stage 3 rules finalized, the APIs we offer are likely to be FHIR-based. Customer adoption will be driven in large part based on their meaningful use stage and participation in alternative payment model programs. Customers will look for solutions that enable them to share information inside their health systems and more broadly across the community. As that need grows, so will the demand for the types of services supported by FHIR.
HealthIT & mHealth: How does FHIR improve interoperability?
Love: The standards in use today are often cumbersome and dated. They don’t take advantage of web-based technologies, and that is the beauty of FHIR. When you combine FHIR with REST, there are many things you can do that are not possible with the traditional HL7 or SOAP-based standards. FHIR not only supports increased granularity, but also modularity. There are smart apps that are FHIR-enabled, which can personalize the user experience. This goes well beyond the things that we can do today.
When you combine the broad industry efforts of CommonWell-type alliances that are solving for patient matching, consent and authorization with FHIR and REST, you can see that person-centered interoperability is possible. Add the market shift to value-based care delivery models that demand levels of care coordination and patient engagement never before required, and we are at a unique place where interoperability is doable.
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