Health Informatics on FHIR: How HL7's New API is Transforming Healthcare PDF
Preview Health Informatics on FHIR: How HL7's New API is Transforming Healthcare
Mark L. Braunstein Health Informatics on FHIR: How HL7’s New API is Transforming Healthcare Health Informatics on FHIR: How HL7’s New API is Transforming Healthcare Mark L. Braunstein Health Informatics on FHIR: How HL7’s New API is Transforming Healthcare Mark L. Braunstein School of Interactive Computing Georgia Institute of Technology Atlanta, GA, USA ISBN 978-3-319-93413-6 ISBN 978-3-319-93414-3 (eBook) https://doi.org/10.1007/978-3-319-93414-3 Library of Congress Control Number: 2018945053 © Springer International Publishing AG, part of Springer Nature 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifcally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microflms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifc statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affliations. This Springer imprint is published by the registered company Springer International Publishing AG part of Springer Nature. The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland “We will be laser-focused on increasing interoperability and giving patients access to their data. Last year, CMS fnalized requirements around EHR certifcation. This ensures that patients will be able to share data via APIs” – CMS Administrator, Seema Verma, HIMSS 2018 _I write this book as I near the end of my 7th decade. This has been a time for refection, in part because we have recently lost so many of the giants of this feld. Some of these people were of great importance to me. Even as I was doing the research for the book, we lost Larry Weed. His book Medical Records, 1 Medical Education and Patient Care opened my eyes to the possibilities of computerized patient records and inspired me to work on an early ambulatory EMR based on his problem-oriented charting principles. Three years earlier, we lost Morris Collen who was instrumental in introducing me and my frst company to Kaiser. While the contributions of the pioneers I profle in this book have been well chronicled elsewhere, those books and articles are often written narrowly for our health informatics community, either because of their technical nature or the venues in which they are published. 1 The Press of Case Western Reserve University, Year Book Medical Publishers, 1969. As in my prior books, it has been my goal to make health informatics more widely accessible to medical students, physicians and other health professionals, patients and nontechnical readers as well as software developers wanting to learn about this rapidly evolving and growing feld. I know from the many e-mails and chance meetings over the years at conferences that my books have often been of service to my intended audience. I hope that this new edition will be equally accessible and will also introduce readers to some of the people who built this feld and to their pioneering efforts. However, the one person I wish to dedicate this book to is thankfully still very much with us! I suppose that most of us dream about changing the world but, of course, very few actually accomplish that. Grahame Grieve is the founder of HL7 FHIR and the FHIR Product Director at HL7 International. I believe he is having a virtually impossible to measure positive impact on health informatics. As a result he is doing as much as anyone to create the safer and more clinically productive and cost-effective global healthcare system that many of us have devoted our careers to. Reading his 2011 post introducing “Resources for Health” (that became HL7’s new Fast Healthcare Interoperability Resources (FHIR) standard) it was clear to Grahame from the outset 2 where things needed to go. I will quote from that seminal post later on but let me briefy describe Grahame whom I consider a friend despite the vast distance between Melbourne and Atlanta. 2 http://www.healthintersections.com.au/?p=502 I had admired Grahame’s work from a distance but it was only when my close public health colleague, Paula Braun, and I arranged for him to give lectures on FHIR at Georgia Tech and at the Centers for Disease Prevention and Control (CDC) that I realized just how brilliant unassuming Grahame actually is. As is often the case with innovation, Grahame came along at precisely the right time with exactly the right ideas. What is not so often the case is that the idea generator also has the people and organizational skills to guide a diverse global group of volunteers toward the desired result. I am sure that I am not the only longtime member of this community who never expected to live to see the dramatic transformation that is taking place in large part because of FHIR. Grahame, we are lucky to have you in the health informatics community, and thanks for all you are doing to move us ahead. I am thrilled to be able to dedicate this book to you and please do not be too angry with me for doing it. Foreword I often kid Ed Hammond that I am grateful he is still around because, if he were not, I might well be the oldest person in our feld! Well into his 80s Ed maintains a schedule that would tax a much younger person. We frst met in 1973 when I was supported by the Duke Foundation to study the British healthcare system over a wonderful summer in London. Ed was one of the instructors. His training up through his Ph.D. was at Duke University. He never left and today, among other leadership positions there and elsewhere, he is Director of the Duke Center for Health Informatics. His career is well described by the presentation speech when he received the highest honor in our feld, the 2003 Morris F. Collen Award of 1 Excellence from the American College of Medical Informatics. Given the focus of this book, it is particularly important to point out that his interest and involvement in health standards literally goes back to “day 1” when, in 1983, he began work with another health informatics pioneer, Clem McDonald, and others to create messag- ing standards for exchange of data among systems, the predecessor to today’s HL7 messaging standard. C omments Dr. Mark Braunstein asked me to share some of my insights on this book. First, I like the book. Mark and I have shared experiences over much of the period of the information age and particularly its use and impact on health care. The book is interesting in its glimpses in the early history and signifcant focus on what is happening today. Reading Mark’s snippets of history, I began to realize that history is defned by writers and what they think is important. Even the most extensive documentation of history leaves out more of history than what is included. I would include different events of history, such as the early work of Lockheed and El Camino Hospital as the beginnings of Hospital Information Systems (HIS) and of 1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC400521/ xi xii Foreword Octo Barnett at Massachusetts General Hospital and the development of MUMPS and COSTAR as one of the early EHR systems. But then, I am defning history as I see it. As I share these insights, I recognize the importance in history that infuenced the development and implementation of standards over the history of time. For both of us history is the transition of technology from a point in which it was the limiting factor to where it now becomes the innovator and enables the vision. We both worked in the world of minicomputers with limited main memory (4 K bytes of main memory), slow computing speeds, slow output speeds (110 baud), cumber- some output devices (teletypes with cloth ribbons and continuous rolls of paper and character-based terminals), to very limited connectivity. The amazing exponential technological progress in all of these areas is important in looking at what the future may cover. Dr. Braunstein does an excellent job of marking this progress from the past to looking at the future. Health Level Seven came into being as a result of a need of Don Simborg and his company to develop a HIS from a cadre of niche vendors. This requirement was met by creating a standard with which data could fow among systems in a standard fashion. Although the basic concepts were defned from previous work done by Simborg, the work by Clem McDonald and others with one of the frst laboratory standards infuenced the actual format and syntax. Strong arguments among the developers were whether we used tags or delimiters. The latter won, because of the cost of transmitting each character was high. The “suggested” delimiters were taken from The Medical Record, developed at Duke University. I think the discussion of the early standards developing organizations (SDOs) is important. Each of the seven or so main SDOs were created for different purposes and not intended to be competitive. However, as the scope of each SDO expanded, scope spread and overlaps occurred. HL7 v2 was not built around X12 syntax. In fact, one of the early battles was between X12 calling itself ANSI, and HL7 was not initially accredited by ANSI. There was a struggle to get HL7 to become ANSI qualifed, but importantly that happened and has been important to HL7 over time. One of the great achievements of this book is explaining a complex, technical topic in a manner that is more easily understandable by lay people. This book talks about how and when to use a standard, rather than the technology of standards or who makes the standard. The breadth and innovative use of these standards will result from clinicians and researchers understanding what can be accomplished with these standards more than the technical community trying to guess at appropriate applications. Dr. Braunstein covers the broad range of standards. His footnotes and URLs provide key links for those wishing to learn more about the topics. He identifes key persons in the standards community. He provides many real world examples. I am impressed with the explorative work of Dr. Braunstein in the use of FHIR. FHIR has been given more hype than any other standard and probably more than any other functionality in health information technology. FHIR will succeed as a result of how it is implemented as well as the functionality of the standard. The fexibility of the standard with extensions to resources may defeat the simplicity of FHIR if used improperly. There is already some push-backs to FHIR and concerns
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