By Janet Rae-Dupree
JANUARY 22, 2020
Medical
professionals have been storing personal health information in electronic form
for more than a decade, but it is cumbersome for patients to gather disparate
computer and paper records scattered across doctors’ offices, hospitals and
medical labs.
Wouldn’t
life be easier if you could view your full medical history with a few taps on
your smartphone?
The
consolidation of medical records may be on its way, as technology companies
prod the health care industry to embrace an internet-based common standard for
storing and sharing patient information. It’s known as FHIR and pronounced
“fire” — a catchier way of saying Fast Healthcare Interoperability Resources.
Industry
analysts say the rapidly growing demand for freer exchange of health care
information is creating an electronic health record market estimated to
reach $38 billion by 2025.
With numbers like that bandied about, it should come as no surprise that
Silicon Valley tech giants Apple and Google are lining up for a slice of the
pie — as are other technology behemoths, including Amazon and Microsoft. Those
corporations, and many smaller companies and startups, offer FHIR-based apps
and services to consumers and health industry professionals.
The
idea behind FHIR is to share specific pieces of information, such as symptoms,
procedures or diagnoses, without passing along entire documents. Each discrete
chunk of data has a unique identifier, which makes it possible for patients,
doctors and researchers to get the information they need on any device or
browser, regardless of where the data is stored.
Proponents
of the new standard say it should ensure that health care information can be
exchanged seamlessly among providers across the industry — from a urine-testing
laboratory in Los Angeles, for example, to a pediatrician in Redding,
California.
When
tech companies can agree to use an industry standard, the adoption of new
technology accelerates: Think Bluetooth or USB. It’s a confusing tangle when
that doesn’t happen: Think laptop power cords.
Adoption
of the medical record-sharing standard may begin to accelerate with the rollout
of a new federal rule
this year requiring health care providers that receive payments from the U.S.
government — Medicare and Medicaid — to use FHIR-compatible apps for patient
data.
FHIR
has met considerable resistance, however. Until recently, there were few
business incentives and limited advocacy by health care providers to create the
necessary demand for FHIR’s adoption, said Micky Tripathi, chairperson of the
advisory council of Health Level Seven International, a
not-for-profit developer of electronic health information standards that
created FHIR.
“Change
will come incrementally over time, not overnight,” Tripathi said. “The older
standards, though inferior, have the advantage that they are in use today and
the cost of ripping and replacing them is not worth the added benefit.”
Some
hospitals and medical clinics put the brakes on the very concept of data
sharing by engaging in “information blocking” in an effort to retain patients.
In 2016, Congress enacted financial penalties to stop them from doing so, but
their resistance has not been eliminated.
“There
have been roadblocks that prevent innovations and data from being widely shared
where it could benefit patients,” said Julia Adler-Milstein, director of the
Center for Clinical Informatics and Improvement Research at the University of
California-San Francisco.
Beyond
its potential to revolutionize medical records requests, FHIR may also provide
the first reliable gateway for patient-generated health information from
millions of smartwatches, fitness trackers and blood pressure monitors to merge
with clinical data in doctors’ offices, people in the industry say.
The
need for a standard arose from the incompatibility of
electronic health records at medical sites ranging from hospitals and doctors’
offices to urgent care clinics and nursing homes.
Digitizing
health records was intended to clean up the chaos of paper-based medical
histories, allowing information to be shared more readily. But many
practitioners still rely on paper, and among
those who have made the digital switch, medical records often lie isolated in
electronic silos.
In
2014, Health Level Seven International proposed
leveraging how the internet works to break open the silos. FHIR evolved
quickly, creating what its product director, Grahame Grieve, calls a “public treasure” of
international health information exchange.
At
UCSF, FHIR is being used in a study to track the weight of newborns
hour-by-hour. UCSF’s Healthy Start program integrates weight data with other
information about each newborn to alert doctors when one of them may be
struggling.
Established
medical technology companies and a host of startups are salivating over FHIR,
because eventually it could give them paths to lucrative uses of data,
including for personalized medicine, population health and medical genetics as
well as in emerging technologies such as machine learning and artificial
intelligence.
“We
want to have FHIR in our analytics and machine-learning tools,” Aashima Gupta,
Google Cloud’s director of Global Healthcare Solutions, said at a conference in
Orlando, Florida, in February.
Tech
giants are already striving to benefit from the growing use of FHIR:
·
Microsoft recently released FHIR Server for Azure, its data-on-demand offering, to attract
health care clients to its cloud services.
·
Google joined with the American Medical Association in an effort
to improve coordination among health care systems with FHIR and develop methods
of collecting and managing patient-generated health data.
·
Apple’s Health Records app uses FHIR to let consumers download
data from their health care providers.
·
Amazon Comprehend Medical works through Amazon Web Services to
offer guidance for health care data specialists using FHIR.
Six big
tech companies — Microsoft, Google, Amazon, IBM, Oracle and Salesforce — have
also joined to support FHIR and broader sharing of health care data through a
government-endorsed project called Blue Button, which is
intended to make it easier for patients to view and download their health
records.
Consumer
advocates and cybersecurity experts warn that personal health information
shared on the web could be compromised. They want to make sure the risk is
minimized before any widespread rollout of FHIR products. Patients do not have
a say in how their health providers store medical information, but patients can
request their records be sent in the format they prefer, including paper.
Facilitating
access to all that data for both patients and providers without first
determining how to keep it secure may open a Pandora’s box that can never be
shut, warned David Finn, executive vice president of strategic innovation
for CynergisTek, a Mission Viejo, California, and
Austin, Texas-based cybersecurity consulting firm.
“We
have to change the way we think about data. It is our most valuable asset. But
we have not adjusted our thinking about data to how the bad guys think of it,”
Finn said. “Until we think about what you could do maliciously with that
information, I’m afraid we will not catch up with them.”
This KHN story first published on California
Healthline, a service of the California Health Care Foundation.
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