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Tech giants support FHIR standard. Will that make a difference?

Six tech giants have vowed to help healthcare interoperability efforts. It could be encouraging, or no help at all. Experts offer their predictions on the value.

During a White House meeting about the new Blue Button 2.0 API for Medicare, six major technology players signed a joint statement pledging to work toward healthcare interoperability with a particular focus on the cloud and artificial intelligence.

The companies -- Amazon, Microsoft, Google, IBM, Oracle and Salesforce -- promised to support the goal of  "frictionless" interoperability using established industry standards, including the HL7 FHIR standard API. They offered a vision of a robust ongoing dialogue that would include every healthcare entity from payers to patients and application developers, according to a statement released by the Information Technology Industry Council.

Pushing the FHIR standard forward

The statement comes at a time when patient demand for easy access to healthcare data has never been greater. Large hospitals have responded with nascent efforts to improve data exchange based on the FHIR standard API, but there is widespread acknowledgement that healthcare lags far behind other industries when it comes to tech innovation and particularly interoperability. The idea of what could effectively be a consortium of mainstream technology companies working on this tricky problem and promoting the FHIR standard was received warmly by some this week and with a healthy dose of skepticism by others.

The fact that the statement called out cloud usage specifically, is telling, because, for reasons ranging from security to cost, a significant portion of healthcare organizations continue to avoid the cloud. A 2017 report from KLAS Research found 31% of hospitals either won't expand their cloud efforts or won't move to the cloud. "The cloud really is a double-edged sword," said Kathy Downing, vice president of information governance,  informatics, standards, privacy and security at the American Health Information Management Association (AHIMA), in an interview. While the cloud might offer a more secure environment than some smaller health organizations could achieve, Downing isn't convinced the cloud itself is pivotal to interoperability. "I don't know that the cloud really has a dog in this interoperability hunt," she said. "You want to think through the safeguards and do all the assessments. That's more important than whether you're using a server or the cloud."

I'm not sure how any of these entities will solve the issue of semantic interoperability.
John Moorefounder and managing partner of Chilmark Research

It's a positive sign for the healthcare industry that it's attracted the attention of these major players, said Coray Tate, vice president of clinical research at KLAS, in an email. But the market has to be there for this to work. "We're at the base of the mountain and early steps are the easiest," he said. "It remains to be seen if the market will provide a business case that will sustain the long climb."

And the business case may not be there because this group of tech companies isn't in most hospitals in any significant way today, said John Moore, founder and managing partner of Chilmark Research, in an email. "As big and influential as these companies are their collective presence in healthcare is quite disparate and at the end of the day it is what a clinician is using in their workflow that matters," he explained. "These companies are simply not there. I'm not sure how any of these entities will solve the issue of semantic interoperability." To further complicate matters, most hospitals don't want to share patient data with competitors, he said. "They have instead opted to let patients themselves take direct responsibility."

Tech support potentially a good thing

Attention from tech giants, however, should be seen as a good thing as long as everyone is thoughtful about how to proceed, said Stan Huff, M.D., chief medical informatics officer at Intermountain Healthcare and co-chair of the Health Level 7(HL7) Clinical Information Modeling Initiative, which developed the FHIR standard API. "This is significant because it creates faith in HL7 FHIR and will encourage investment in FHIR development," he said. "The thing I would want to encourage is that this group work with existing organizations like HL7, ONC, HSPC and CIIC to ensure they all implement the FHIR standard the same way so we get to true semantic interoperability at some point."

The joint statement offered few details on future plans but stressed the need to get everyone involved, including the open source community. "I think we will need to wait a few weeks to hear specific projects to know what additional impact they will have," Huff said.

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