EHR Vendors and the Use of FHIR

Published: November 13, 2023

Cranfield, UK, In recent months, Signify Research has engaged with numerous EHR vendors to discuss their perspectives on Fast Healthcare Interoperability Resources (FHIR), its application in the platforms they offer, and their approaches to dealing with FHIR regulations. Several of the key takeaways are:

  • FHIR is revolutionising healthcare by enhancing interoperability and enabling various healthcare IT systems to efficiently share information, which is crucial for the shift from FFS to VBC.
  • By standardising data exchange methods, FHIR is improving consistency in healthcare data and supporting the delivery of personalised and effective patient-centred care.
  • EHR vendors face significant challenges in keeping up with the evolving regulatory landscape of FHIR, balancing compliance with innovation, and dealing with the complexities of implementation, including the scarcity of skilled professionals.
  • EHR vendors are actively collaborating with industry consortia such as CommonWell and Argonaut to stay ahead of regulations. FHIR allows vendors to offer custom integrations and analytics that enhance patient care and healthcare organization insights.

Introduction to FHIR

FHIR is a standard in healthcare data exchange, that is helping to improve interoperability and the way healthcare information is shared between various healthcare IT systems.   Since moving from the traditional Fee for Service (FFS) model to Value-Based Care (VBC), there has been a marked increase in the need for sharing and accessing data in real- and non-real time applications. This change is crucial for effectively analysing data to not only improve health outcomes but also to provide personalized care to patients.

Developed by Health Level Seven International (HL7) in 2012, FHIR has gained popularity over the last decade and has become an instrumental tool for healthcare organisations, providers, payers, and health IT vendors by making data transfer considerably faster, easier, and more efficient. FHIR is free, open-source, and combines the best features of HL7’s earlier standards with a common set of APIs so various healthcare platforms can communicate and share data across facilities in a way that each platform can understand.  It also uses the latest web technology which helps to make it easier for developers to implement.

The Office of the National Coordinator for Health Information Technology’s (ONC), and the Centers for Medicare & Medicaid Services (CMS) are the regulatory bodies that develop FHIR regulations in the US. The elements of the 21st Century Cures Act relating to information blocking have accelerated the use of FHIR to address the information sharing elements of the Act.

Benefits of FHIR in Healthcare

While the healthcare industry continues to encounter challenges in data exchange, FHIR has contributed to reducing these challenges. Prior to the introduction of FHIR, the industry relied on inconsistent ways of exchanging data.  Through FHIR, hospitals can now fast-track the sharing and accessing of critical patient information, thereby promoting timely and informed treatment. FHIR has facilitated the following improvements in healthcare data exchange:

  • Interoperability of data: FHIR allows various healthcare IT systems and platforms to communicate with each other, regardless of which vendor the platform comes from. HCPs and other healthcare practitioners can access patient data regardless of where the data is located.
  • Standardisation: FHIR establishes a standardized set of resources and data elements for exchanging healthcare information. Standardising the format and structure of healthcare data through FHIR helps in maintaining consistency across the various systems in the healthcare industry.
  • Patient-Centred Healthcare: FHIR aids in allowing healthcare providers to have access to more information real-time. This helps them offer more personalized and effective care, enhancing the overall quality of healthcare services.

FHIR is also designed to support modern web and mobile applications, making it a suitable standard for developing patient-facing apps and other digital health tools. Through this, patients can easily access their health data and be more involved in their healthcare.

The Utilisation of FHIR by EHR Vendors

Signify Research has had the opportunity to discuss with various mid-sized and small EHR vendors regarding the use of FHIR in their IT architecture. These conversations provide insight into how EHR vendors currently use FHIR and the challenges that they face with implementations.

The majority of healthcare data is stored in EHRs, leading to both healthcare providers and patients depending heavily on them. Interoperability using FHIR is now a key feature of an EHR vendor’s IT architecture. It provides a standard way of sharing information between clinicians and healthcare organisations, regardless of how the data is collected.  The following figure depicts the various use cases of FHIR within EHR vendors’ IT architecture.

Figure 1: Use cases of FHIR within EHR architecture

Challenges Faced by EHR Vendors

The adoption or implementation of any standard or protocol invariably comes with its own set of difficulties for users.   In our conversations with EHR vendors, most mention several challenges they face while implementing FHIR within their IT.

Meeting ONC and CMS regulatory and compliance needs is not only each vendor’s topmost FHIR priority but also their number one challenge with it. The regulatory landscape of FHIR is constantly evolving, and EHR vendors want to ensure that they are always compliant.  Failing to remain in line with these regulations could result in the loss of their customers. Vendors struggle to find a balance between keeping up with regulatory deadlines   and investing in their products. Regulations become a distraction, forcing vendors to divert the available financial and technical support into meeting regulatory needs rather than in the business of developing innovative products.

EHR customers nowadays have specific expectations regarding the interoperability of EHRs. They seek solutions that offer out-of-the-box interoperability, expecting the EHR to seamlessly integrate with a diverse range of tools and systems they already use. However, they are unaware of the many complexities that EHR vendors face. Vendors also struggle to strike a balance between benefiting their customers and making a profit from developing these integrations.

Moreover, FHIR implementation guides are live documents that keep evolving due to different use cases, causing vendors to keep making changes to their solutions before going to market. This need for continuous adaptation leads to frustrations as they strive to keep up with the latest updates.

Another critical challenge is the scarcity of human resources, particularly the lack of professionals equipped with the necessary skills and thorough understanding of the healthcare domain essential for handling complex health data. Finding people with sufficient technical skills and experience in the healthcare sector can become difficult for vendors, forcing some to outsource to external experts leading to higher development costs.

How EHR Vendors are Keeping up with Regulatory Changes 

To remain up to date with compliance deadlines and requirements by the ONC and CMS, EHR vendors have established dedicated internal teams that focus on navigating the ever-changing regulatory landscape. They also maintain active collaborations with groups and consortia like Argonaut, CommonWell, and DaVinci to support their efforts, providing them with collaborative platforms to ensure they are prepared for any forthcoming regulations.   These are more industry collaborations around FHIR where private sectors including payers, providers, health IT vendors collaborate to improve interoperability in shift to VBC, and to advance industry adoption of FHIR standards.

Market Opportunities for EHR Vendors 

FHIR has created a vendor ecosystem focused on services and solutions to help healthcare organisations with data exchange and interoperability.

Adopting FHIR not only aligns EHR vendors with current technological trends and standards but also opens new opportunities for innovation, collaboration, and customer engagement. It positions them strongly in a competitive, evolving healthcare market, where adaptability and user-centred approaches are key. FHIR presents a chance for vendors to deliver innovative healthcare IT solutions centred on collaboration and partnerships, particularly considering the expanding VBC market and increasing accountability for quality of care. Vendors can connect their EHRs with various healthcare platforms and systems by offering custom FHIR integrations as needed. Considering the complexity of FHIR, vendors have an opportunity to build user-friendly interfaces for providers and patients.

Vendors can also incorporate more analytics engines alongside, or as a component of, their EHRs that leverage FHIR standards to aggregate and analyse datasets. Further, it makes it easier for data from not only one EHR to be used in this process, but multiple EHRs alongside additional data sources (payer data, other hospital IT systems, etc.)  This functionality will enable healthcare organisations to gather insights into patient care and health trends though predictive models, visualisations, and dashboards.

Nonetheless, challenges persist due to limited interoperability. Not all EHR vendors fully use the entire range of FHIR standards, often constrained by their existing APIs. The process of creating custom integrations is both time-consuming and costly for vendors. Innovation faces hurdles – the use of legacy EHRs and paper-based systems is slowing the adoption and implementation of FHIR.

Future of FHIR 

It goes without saying that FHIR will be a central feature of healthcare IT for the foreseeable future, the challenge lies in adapting to an environment where standards and regulations are not only diverse but also continually evolving. As EHR vendor competence in working with FHIR increases, this regulatory push and customer pull will be joined by vendors embracing FHIR as a tool for innovation and new revenue opportunities.

Despite the challenges, the insights gained from our discussions with EHR vendors indicate a trend towards strategic and compliant use of FHIR, with an emphasis on collaboration and ongoing innovation.  By using FHIR standards as a catalyst, EHR vendors can harness and leverage healthcare data effectively to contribute to a more integrated, efficient, and patient-centric healthcare system.

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About Mohita Deshpande

Mohita joined Signify Research in 2023 as a Market Analyst. She has an undergraduate degree in Dentistry from India and a master’s degree in Public Health from the University of Warwick.

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