By David Fletcher, MPH
Vice President of Innovations, Streamline Health, Inc.

Thank goodness healthcare is finally pursuing solutions to deliver a holistic view of a patient’s life. This means that, along with the data needed to support our encounters with any given patient, we’re also engaging with other care providers (usually working for different organizations) to gain insight from their encounters with that patient to truly understand the patient’s overall health. We’re actively tracking patients in populations who aren’t currently sick in an effort to better understand how to support them in their wellness activities. We’re eager to gain access to the data being generated by a host of fitness devices, medication tracking pill boxes, CPAP sleep machines, home blood pressure monitors and the like.

Whether it’s large medical delivery networks exchanging massive amounts of clinical data from EMRs,  billing systems designed to keep a doctor’s office in business, or an engaged patient who wants to push data from a personal device to her medical record in her doctor’s office, the bottom line—and overarching challenge—is simple: our healthcare technology systems must be able communicate. They must be interoperable: capable of exchanging information with other systems. Sounds obvious, but there are plenty of obstacles preventing this. If it were simple or easy, regulations such as Meaningful Use wouldn’t be necessary.

To move towards this interoperability, you must first have the business will to do it. For an HIT provider, isolating data can provide a distinct competitive advantage, allowing them to control or limit data access. This might have worked in the 1990’s but healthcare reform has changed this approach forever, and for the greater good. Interoperability enables the democratization of health data, which is important because it means more providers can access the data that provides the “big picture” of a patient’s life.

After establishing that you want interoperability, you must then address the technical barriers that can prevent two systems from exchanging information. Many factors contribute to lack of compatibility in HIT. Maybe the systems each require a unique type of server, or perhaps they can only send/receive messages in a highly specific format.  Overcoming these singular issues is often called point-to-point integration. However, this approach is extremely limiting and impractical to use on a large scale basis.

For true interoperability that is flexible and scalable, smart HIT system vendors are using an enterprise service bus (ESB) approach. An ESB is an architecture that treats each separate system as a service. The services can securely exchange data and make requests of each other. Imagine the following exchange between systems via ESB:

“Hey, Enterprise Content Management system. I need a physician query completed but I’m not allowed to issue the query directly. Can you do it for me and send me back the result?”

 “No sweat, Coding system. I’ll send the query and share the results when it’s been completed.”

Two systems that have never been previously integrated are now able to share work and information, yielding the needed HIT interoperability while still maintaining their own sovereign functionality. Suddenly, the world expands and not only are the HIT functions in an organization easier to manage; the perspective on the patient’s life is broader.

To truly understand the potential impact of ESBs, consider the common scenario of information that multiple systems need access to, such as patient registration data. When a new patient is registered there may be several dozen systems that need to be alerted, as well as needing access to key registration data. ESBs are really good at blasting the information to all “subscribing” systems and making sure that the message gets through. And again, it doesn’t matter what technology these subscriber systems are based on; the ESB will get that information to the destination systems, securely and efficiently.  Using an ESB breaks down technical barriers and helps us assemble a holistic view of our patients.

Things get really wild when we add fire. Fast Healthcare Interoperability Resources (FHIR), which is pronounced “fire”, is an emerging technical standard from HL7 International that defines a simple way to send clinical data. At its core, FHIR enables data-level access—as opposed to a document-centric approach—using RESTful APIs and secured using OPEN ID and OAUTH tokens. It standardizes information in a way that subscriber systems will know exactly what is coming across the ESB. “I’m a blood pressure reading and my value is 120 over 80. Furthermore, here’s a good way to display me: 120/80”. FHIR standards are enabling the simple, secure, and standardized exchange of data about patient encounters, medications, observations, test results and more.

Using FHIR, an ESB can serve as a clearinghouse for all subscribing services. From this single point of entry, data can then be distributed to all underlying systems, including the EHR, billing system, coding, etc., for their use in completing deficiencies, supporting workflows and more.

Between the ESB that allows many systems to communicate and FHIR, which brings intrinsic meaning to the information being exchanged, healthcare interoperability is becoming more common and accessible. “FHIR on the Bus” is a crucial approach to creating an expanded view of patient health that will improve care outcomes and reduce the resources needed to keep our communities healthy.