Industry Pushes FHIR-Native Architectures
Industry leaders are increasingly promoting the use of FHIR-native microservices as the future architecture for health IT systems. This approach is favored for creating modular, scalable systems that can be upgraded more easily. It also allows for more nimble responses to evolving regulatory requirements from agencies like CMS and ONC.
- A significant barrier to the adoption of FHIR-native architectures is the integration with legacy EHR systems, which often use proprietary data formats and lack the modern API capabilities required for seamless FHIR implementation. Overcoming this often requires costly and complex custom interfaces or middleware. - Frustrations among frontline nurses with current health IT systems stem from fragmented system landscapes, poor usability, and a high number of clicks required to perform tasks, with some studies indicating that nurses can spend over an hour per workday struggling with IT systems. These issues are seen as compromising patient safety and detracting from direct patient care. - Epic, a widely used EHR, utilizes FHIR through its App Orchard and supports various FHIR versions, including DSTU2, STU3, and R4, to allow third-party applications to integrate directly into its Hyperspace platform. However, resource support and permissions can vary by the specific Epic site and FHIR version being used. - For nurses transitioning to informatics, the Nursing Informatics Certification (NI-BC) is a key credential, requiring practice hours in informatics nursing or completion of a graduate-level program with a relevant clinical practicum. Additionally, certifications in HL7 standards, such as the HL7 FHIR Proficiency Exam, can demonstrate valuable expertise. - Regulatory mandates from the ONC and CMS are major drivers of FHIR adoption. The 21st Century Cures Act and subsequent CMS rules, like the Interoperability and Patient Access final rule, require the use of FHIR APIs for patient data access, provider directories, and payer-to-payer exchange. - A FHIR-native approach uses microservices that incorporate FHIR standards from the outset, organizing information into discrete "resources" like "Patient" or "Observation," which simplifies data exchange and eliminates complex conversions. This architecture allows for individual services to be scaled independently, enhancing the resilience and scalability of healthcare IT systems. - While FHIR is a powerful tool for interoperability, its implementation can be challenged by the evolving maturity of the standard, variability in adoption across different EHR systems, and the significant upfront investment of time and resources required from health systems. - Key initiatives accelerating the adoption of FHIR include the Argonaut Project, which focuses on implementing FHIR to support value-based care, and the Da Vinci Project, which aims to help payers and providers exchange critical data for improved clinical, quality, cost, and care management outcomes.
