A rundown of EHR and FHIR

For healthcare providers, the exchange of electronic health records (EHR) is an important task. Making sure that records can be exchanged between different providers and with patients safely is the primary concern. The security and privacy of these records is key and it’s what prompted the Fast Healthcare Interoperability Resource (FHIR). This standard offers an efficient solution that can help healthcare organizations share medical data across systems and devices. With its wide array of options for developers, FHIR provides a robust framework for creating new systems to better serve patients.

Below we explain what EHRs are, why they’re important and why the use of FHIR has risen in the last few years.

What are EHR

Keeping patient records on paper can be mind-numbing and time consuming for healthcare professionals, and with today's consumers and healthcare providers wanting quick access to health data and information without having to physically go to the physician's office, digital solutions have become a necessity.

Medical records are usually stored in an Electronic Health Record (EHR or sometimes referred to as EMR) which is a type of record-keeping system for both healthcare providers and patients. The EHR was developed to create a standardized system for storing records, which includes demographics, healthcare information, medical history, diagnostic images and laboratory test results.

While it’s true that some people may use the terms Electronic Health Record (EHR) and Electronic Medical Record (EMR) interchangeably, they have distinct differences that are important to bear in mind.

EMRs are sometimes referred to as the first iteration of EHRs – they are essentially the digital version of a patient's paper chart. EMRs focus on a patient's various diagnoses and treatments and can be used to help track data over time. EHRs on the other hand go beyond the information stored and entered by the original health provider, they cover a much wider scope of documentation and analysis of a patient's health and medical history. They are even capable of assisting with healthcare management functions such as billing and scheduling.

With the establishment of the Office of the National Coordinator for Health Information Technology (ONC) and the development of several initiatives like the HITECH Act and Meaningful Use, electronic health records are becoming increasingly important. The ONC is an entity within the U.S. Department of Health and Human Services (HHS) whose purpose is to promote a national health information technology (HIT) infrastructure and oversee its development. ONC is associated with nationwide efforts to provide electronic health records to patients as a way to better curb medical errors and eliminate paper records.

Importance of EHR

Electronic health record systems are meant to improve two key areas in the healthcare field: physician productivity and patient satisfaction. The implementation of EHR will accelerate physician diagnosis and also digitize and accelerate administrative tasks. The patient’s data will be accessible 24/7 and they will have a better hold on monitoring and controlling their own health.

All in all the key benefits to the easy and secure exchange of EHR are:

to improve the coordination of care and information among different healthcare providers such as hospitals, labs, physicians and other healthcare organizations;
to ensure that personal health records remain secure; and
to promote the early detection, prevention and management of chronic illness.

The implementation of electronic health records is a long and complicated process. The biggest hurdles stem from interoperability and data privacy.

Interoperability

Interoperability is the ability of different software systems to share and exchange data. It’s also the biggest challenge the healthcare industry has when implementing EHRs. Since the key perk to using EHRs is the ability to share patients' medical history across a variety of healthcare providers, accurate interoperability of data is critical. This along with data security and patient privacy are the biggest obstacles of implementing EHRs.

Successful EHR implementation also requires continuous employee training. Healthcare providers must consider what software is best for their needs and how they will migrate paper documents to digital records. They must also have a contingency plan in place in case the system is ever down. Physicians must be trained on the entire EHR system so they can take advantage of all it has to offer and so there’s less of a risk of them reverting back to paper format.

The government has been incentivizing the implementation of EHRs across the country among different healthcare providers. The Centers for Medicare & Medicaid Services (CMS) launched the Promoting Interoperability Programs designed to assist healthcare professionals and organizations to meaningfully use EHR technology.

The program has evolved through three stages:

Stage 1: set the foundational requirements for recording patient health data electronically
Stage 2: CMS encouraged healthcare professionals to use EHRs to exchange patients' health data and emphasized the importance of quality improvement and meaningful use.
Stage 3: Provides physicians with the current requirements for the Promoting Interoperability Programs. Many points were carried over from stage 2, emphasizing the importance of quality of care and working to improve patients' health outcomes.

What is FHIR

In order to efficiently capture and share patient data, healthcare providers need certified electronic health record (EHR) technology (CEHRT) that stores data in a structured format. Structured data allows health care providers to easily retrieve and transfer patient information and use the EHR in ways that can aid patient care.

CMS and the Office of the National Coordinator for Health Information Technology (ONC) have established standards and other criteria for structured data that EHRs must meet to qualify for use in the Medicare Promoting Interoperability Program.

The Fast Healthcare Interoperability Resource, commonly known as FHIR, is a standard for health care data exchange, published by HL7. FHIR is a healthcare-specific interoperability protocol that allows EHR to be exchanged between healthcare providers and patients.

According to HL7’s website "The philosophy behind FHIR is to build a base set of resources that, either by themselves or when combined, satisfy the majority of common use cases. FHIR resources aim to define the information contents and structure for the core information set that is shared by most implementations,"

FHIR hopes to allow developers to build standardized browser applications that will enable access to data no matter what EHR operating system underpins the user's infrastructure.

Why choose FHIR over other standards?

Most health information exchange and data interoperability is based on single or loose documents. These can be either faxed, emailed, or sent electronically, and providers typically have to choose a set of data to transmit and generate a message containing only that data.

This approach does help healthcare providers successfully communicate and share data with each other, but it can be somewhat limiting for actual care coordination, decision making, or data analysis. This document-based exchange doesn't allow a provider to dive into the context of the data received because what is being transmitted is a single document (lab work, blood test results, etc.). Providers need access to the patient’s entire records so they have more context and can better diagnose and treat those patients.

This is where the importance of FHIR comes in; it allows developers to create apps that go beyond the single document-based sharing environment. Applications can be plugged into a basic EHR operating system and feed information directly into the provider workflow, avoiding the restraints associated with document-based exchange.

Before FHIR, HL7 was the standard that was used. It’s a clinical messaging format that supports the secure exchange of documents and healthcare messaging between healthcare organizations. FHIR was released in 2014, as an alternative to HL7 v2, as an open standard that enables new applications to more easily exchange data than in the past. FHIR aims to accelerate the implementation of HL7 and allow users to gain access to medical data from various devices.

FHIR promises to improve information sharing, simplify implementation, and offer better support for mobile applications. It will also facilitate patient data sharing between clinicians to provide overall better coordinated care to patients and enhance critical decision-making.

How does FHIR work

FHIR is focused on simplifying implementation without sacrificing the integrity of patient data. It provides a consistent, easy to implement, and rigorous mechanism for exchanging data between healthcare applications.

It contains two sections: content model in the form of ‘resources’, and a specification for the exchange of these resources via RESTful interfaces as well as messaging and documents. These resources can easily be assembled into working systems that solve real world clinical and administrative problems at a fraction of the price of existing alternatives.

FHIR is suitable for use in a wide variety of contexts such as mobile phone apps, cloud communications, EHR-based data sharing, server communication in large institutional healthcare providers, and much more.

According to the ONC, the FHIR standard provides many advantages to software developers such as:

A strong focus on fast and easy implementation; (reports say simple interfaces can be implementable in a single day)
Free to use with no restrictions.
Support from major vendors including Apple, Microsoft, Google, Epic, Cerner, and most other EHR vendors.
Many free, online, and downloadable tools, including reference servers and implementation libraries
Many public examples available to help kick-start development of new applications.
An evolutionary development path from earlier HL7 healthcare standards (such as Version 2)
A strong foundation in web standards including XML, JSON, HTTP, and OAuth.
A global community to assist implementers.

The future of EHR

The use of EHRs has become fundamental in the physician-patient care experience in recent years. However, it’s up to innovative tech companies to develop new ways to make these systems more useful and user-friendly.

According to Business Insider, the Global Electronic Health Records (EHR) market was valued at USD 20.55 billion in 2016 and is expected to reach USD 33.41 billion by 2025.

Going forward we will start to see new trends emerge such as adopting agile approaches. An accelerated deployment methodology can help healthcare providers cut back on costs by reducing implementation times and costs.

The implementation of voice assistance and language processing is something that could streamline data entry and medical record searches. For example, searching for a patient’s medical history using voice commands can make the process more efficient for healthcare providers. Medical professionals could also use it to write patient notes and update their charts, implementing a keystroke-free approach.

Another area where innovation is necessary is accessibility. Developments in this area will help to shorten the visit time per patient while increasing accuracy in tracked patient data. Companies will need to start creating purpose-built solutions such as location data, messaging, and more.

Last but not least are telehealth platforms. They have become vital as a result of the pandemic and they demonstrate the value of remote patient care. Technology companies can drive integration in this area by enabling virtual care visits to be launched through EHR platforms, the same place where records will be tracked and maintained. This is becoming increasingly important with the increasing demand for fully connected and mobile EHR devices (tablets, phones, smartwatches, etc.).

Physicians want and need patient data to be provided and presented to them in a useful way. FHIR is exactly what's needed for electronic health records. It could link the patient-generated health data from Apple Watches, Fitbits, bluetooth scales, blood glucose monitors, diet apps, and other fitness trackers to the patient’s EHR. This pool of data is growing every day.

Since the creation of the EHR, medical information has become steadily more accessible, making it easier for patients to manage and share their records. But with this evolution also comes new challenges to security. While a single system can now deliver seamless communication, it’s still important to ensure that access is carefully monitored and restricted. The FHIR standard has a lot to offer the healthcare world. From providing consistency and security between all involved parties, to also allowing real-time access by authorized medical staff.