A sure-FHIR way to faster, safer and better care

We live in a digital world where a complex task can be carried out in a few clicks. Sensitive and secure information is shared seamlessly. Money moves between bank accounts. People connect virtually over vast distances.

Even though the digital revolution has transformed so many aspects of our lives, particularly when it comes to ecommerce, the full benefits for healthcare are still waiting to be unlocked.

As patient data is digitised, paper-based communication has been scaled back across hospitals, pharmacies and general practice (GP) clinics.

However, one of the biggest challenges to realising the true potential of digital health still remains.

Data exists in siloed systems with different computer systems or software unable to communicate effectively, preventing the seamless transfer of information between healthcare providers.

It means that even as electronic medical records (EMRs) are rolled out across Australia, diagnostic, clinical health and administrative health data, is shared using faxes, letters and via the telephone.

But an Australian invention, known as Fast Healthcare Interoperability Resources (FHIR) and pronounced ‘fire’, could solve the conundrum and create truly digital and connected healthcare.

Professor Chris Bain, Monash’s first Professor of Practice in Digital Health, Faculty of Information Technology (IT) said FHIR was an internet-friendly way of standardising healthcare data.

It provides an ‘agreed language’ for different systems to communicate. The goal is to make health data more accessible to those who need it, when they require it.

“FHIR has the potential to reduce medical errors, make enormous efficiencies in the healthcare system, and innovate in ways that will improve everything from the way a patient is diagnosed to how they are treated,” Professor Bain said.

The Founder of FHIR

Grahame Grieve has previously shared with the media that it was a deeply personal emotional crusade that first prompted him to find a way to make digital health data ‘shareable.’

Known as the Father of FHIR, Grahame’s family’s own painful journey through the healthcare system and the experiences shared with him by others, convinced him to act.

It became clear that even when the clinical care is first-rate, the fragmented healthcare system urgently needed addressing.

He vowed to find a way to ensure that the right information would be shared at the right time with the right people, to stop small gaps becoming giant chasms that people can fall into.

The holy grail of interoperability

Professor Bain said FHIR was now widely accepted as healthcare’s best chance of improving the interoperability of data contained in EMRs.

It would allow a GP to access aspects of their patient’s recent hospital admission, so they can support their care in the community (with the patient’s permission and the necessary safeguards in place).

“We don’t need to telephone, fax or write a letter because the infrastructure allows us to do this,” Professor Bain said.

“FHIR allows for a seamless transfer of information, just like you can do when you automatically transfer money from one bank and branch to another.

“For the first time ever, it allowed us to contemplate sharing detailed information like a patient’s blood pressure, last Tuesday at Dr Smith's clinic at 2:20pm, with an expert on the other side of the world, with the right permission and security in place,” he said.

Benefits outweigh concerns

Professor Bain said privacy was a commonly raised concern, but he pointed out that most problems in healthcare arise from our inability to share information.

“No one ends up in the Coroner’s Court because too much information was shared between healthcare providers - the opposite is true.”

As well as reducing the risk of catastrophic mistakes, making health data more shareable will lead to greater efficiencies.

“When I was a resident doctor, I spent half my time trying to find information. I can’t find the test results, so I order a new test even though I know one was done an hour ago.

“If you have been around healthcare, you understand all the times that the inability to seamlessly and accurately access and share information causes problems and they trickle down to the patient.”

It’s not just the interoperability of healthcare data that could be enhanced by FHIR, it may also allow ‘data liquidity,’ where information can flow from one place to another.

Making innovation easier

FHIR has another benefit.

It uses a standard way of sharing information online and contextualises it for healthcare.

This means that people don’t need to be experts to work with it, they just need to have an understanding of data-exchange formats, such as JSON (JavaScript Object Notation) to represent data.

Dr Aldeida Aleti, Associate Dean of Engagement and Impact, Faculty of IT, is using FHIR to develop telehealth consultations for people living in remote and regional areas, who struggle to access a GP or specialist.

“FHIR is going to completely revolutionise healthcare in Australia and it will allow software designers to be more innovative,” Dr Aleti said.

One way this can be achieved is by using a technological platform called Substitutable Medical Applications and Reusable Technologies (SMART) with FHIR.

It allows research organisations and digital health companies to build third-party medical apps, which can be integrated with the electronic health records to allow individuals to tailor the technology to their needs.

The potential of these two technological platforms is only limited by the imagination.

Already there are apps that help calculate a person’s 10 year risk of heart attack and stroke, or allow emergency medics to search a patient’s medical history for reversible causes of Pulseless Electrical Activity (PEA) cardiac arrest.

The next generation of software developers is being introduced to FHIR and challenged to solve real world problems using the technology.

Success requires quick uptake

Dr Amin Sakzad, is a lecturer in the Department of Software Systems and Cybersecurity, Faculty of IT, who helped set up the FHIR infrastructure at Monash.

“We set up a server to enable us to use FHIR for research, teaching and programming competitions,” Dr Sakzad said.

Monash was the first university in Australia to set up an innovative national digital health programming competition using gamification as a learning tool outside the classroom.

“We used the FHIR server to provide access to thousands of fake medical records and we gave students some practical questions that health professionals may want answered.

“For instance, a GP or researcher who wants to know the average blood pressure of Australian women aged 40-45.”

The competition has been incredibly successful, and it will soon be extended to other Victorian universities and hospitals.

Professor Bain said Monash University was fostering the FHIR ecosystem because its success was dependent on how widely, comprehensively and quickly it was embraced.