Aug 22 2022

How Healthcare Organizations Can Overcome Barriers to FHIR API Implementation

Application programming interfaces for the healthcare data exchange standard will help providers improve interoperability. But cost and lack of IT talent require careful integration planning.

As the healthcare industry prepares for the Fast Healthcare Interoperability Resources (FHIR) standard to replace HL7, many healthcare organizations are facing integration headwinds ranging from cost of application programming interface (API) implementation to security concerns.

According to a recent HealthTech Twitter poll of health IT leaders, cost is the top barrier to implementation, while others cited a lack of qualified IT personnel and lack of infrastructure as major challenges.

FHIR is a data encoding standard — analogous to HTML — but built specifically for formatting or “encoding” health data. This could include a person’s identity, health history, clinical encounters, diagnoses, prescriptions or any other aspect of healthcare relating to a person.

FHIR documents can be exchanged over web services, and an FHIR API facilitates the exchange of those documents.

Christian Carmody, senior vice president of the University of Pittsburgh Medical Center IT Division and UPMC's CTO, notes that FHIR APIs being developed aren't fully baked yet.

“There’s still a lot of work to be done, which is where the cost comes in and the infrastructure comes in to support that,” he says. “Typically, with newer technologies and newer standards, there’s always that adoption curve.”

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The Cost of FHIR API Adoption in Healthcare

Carmody explains that at UPMC, there are many different interfaces and data exchanges currently in use.

“You already have those costs to support the current environment from an infrastructure perspective, and now you’re taking on new capabilities that warrant some investment to make them happen,” he says.

That includes investment in additional security measures such as data encryption for personal health information transferred between parties.

LEARN MORE: Will the FHIR standard revolutionize healthcare interoperability?

“There are additional costs that come with supporting the additional infrastructure, whether it’s within a data center or the cloud,” Carmody says. “Those costs will continue to grow. That’s where the costs are additive from an adoption perspective.”

Jason Warrelmann, UiPath's global director of healthcare and life sciences, agrees, noting even though the adoption of FHIR allows healthcare organizations to increase interoperability, there is still a huge cost associated with sharing data.

“Since the installment of the FHIR standard, healthcare systems have been trying to reduce the cost of data abrasion and manage the simplification of some of the administrative weight that surrounds the use of data,” he says.

Breaking Down Barriers to FHIR API Adoption

One way healthcare organizations can reduce costs is by leveraging FHIR-enabled automation software to open new clinical use case opportunities inside the health system, as well as sharing information between health systems.

Warrelmann adds that with the adoption and implementation of government-regulated open API standards and FHIR setups, healthcare organizations are quickly realizing they lack the internal processes to manage data governance and that their electronic health record platform has yet to be optimized to take full advantage of the data integrations.

“The barriers to adoption will take time to overcome as EHRs mature to handle both two-way API, custom API development and the secure sharing of FHIR-based data in a peer-to-peer exchange,” he explains.

DISCOVER: What you need to know about FHIR vs. HL7 v.2 for healthcare interoperability

Miles Romney, co-founder and CTO of eVisit, says without an appreciation for the potential breadth and complexity of the migration effort, it’s easy to become frustrated with unmet expectations.

“In migrating from HL7 v.2 or a proprietary format to FHIR, the data exchange engineers will be teaching maybe a dozen different systems to speak a new language — a highly technical new language,” he says.

From Romney’s perspective, however, in many instances using FHIR will be a bit like swatting a fly with a sledgehammer.

“It has been designed to accommodate everything in healthcare, which necessarily means that it will be overwrought for many simpler tasks,” he says. “But it is highly modular, so this can be mitigated to some degree.”

Health IT Collaboration Can Improve Interoperability

Carmody emphasizes the importance of health IT professionals sharing experiences and best practices with one another to determine FHIR API challenges and define best practices.

“If you’ve blazed that trail, sharing that information with others can make sure their process is a bit more frictionless as they adopt a new standard like FHIR within their environment,” he says.

Miles Romney
Progress may be hard, costly and inconvenient, but it’s nearly always worth it. It certainly is in this case.”

Miles Romney Co-Founder and CTO, eVisit

Romney adds that if the organization has capable IT professionals, it’s important to give them the mandate, time and resources they need to learn FHIR themselves, and then the space to implement it.

“It will nearly always be worth the cost of engaging a specialist, either as a new hire or as a consultant, if you don’t have one in-house,” he explains.

If health IT leaders find the estimate that their internal team gives them is much lower than the one they receive from a specialist shop, Romney suggests they lean conservative.

“Progress may be hard, costly and inconvenient,” he says, “but it’s nearly always worth it. It certainly is in this case.”

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