The unfortunate paradox for promoting work around standards is that if integration engines are working well, no-one hears about it – it’s only when it goes wrong that it gets attention.
1. A BOTTOM-UP APPROACH
Development of standards typically begin with an enthusiastic group of volunteers but until FHIR® reaches a level of maturity, governments are not likely to write it into regulation – and adoption is likely to be slower. HL7 V3 was largely successful in the Netherlands, Canada and England as the standard was used to support interoperable electronic health records programmes.
2. INVESTMENT IN PREVIOUS STANDARDS
Standards have been around for over 30 years and many health providers have invested millions in funding and resource to develop their digital maturity. FHIR® could disrupt interoperability programmes where standards are already in place, delaying the realisation of benefits.
3. POTENTIAL THREATS FOR VENDORS
Some IT vendors could be threatened by FHIR®’s ability to shorten deployment times of major systems like a shared health record (through simplicity and speed of implementations) which would, in turn, reduce revenues. Integration providers that promote speed and ease of deployment, such as Enovacom, are actively encouraging FHIR® adoption to support transformation.
4. LACK OF VISIBLE CASE STUDIES
Health and care is a historically risk-adverse industry and very few health providers actively promote innovation. The HL7 FHIR® community are very proactive in sharing best practice and FHIR® in action, however these examples are sometimes not promoted more widely outside the FHIR® enthusiasts. Broader dissemination of FHIR® case studies to healthcare providers who adopt a ‘wait-and-see’ approach is imperative.
5. LACK OF OWNERSHIP
Despite its rapid maturity, FHIR® is reliant on a community of groups or teams developing it. The UK’s INTEROPen and France’s Interop’ Santé are examples of proactive groups that are developing FHIR® standards for specific use cases but a wider roadmap is not in place to meet holistic healthcare challenges.
6. FAST DEVELOPMENT, BUT FAST DEPLOYMENT?
Rapid and easy implementations are a key characteristic of FHIR®, however, the standard and the projects it supports can only be deployed at a pace that each healthcare organisation can manage. Many healthcare providers are not clear on the resources required for the development of messaging, terminologies and interoperability standards. Changes in IT infrastructure are also required to include FHIR®, whilst investment in ongoing maintenance, support, education/training will be required.
7. STRATEGIC FIT
Many healthcare IT teams are under enormous pressure to keep current systems performing and reacting to short-term challenges. Large IT strategies are being undertaken daily, but how does FHIR® fit in? Many people associate FHIR Standard with REST protocol and as a storage standard for databases, but there are many ways it can be used such as documents, messages and services.