5. FHIR®: AN NHS PERSPECTIVE
Interoperability is high on the agenda
The NHS, short of funding and facing rising demand for services, is undergoing considerable reform in its use of IT. Interoperability is seen as a key priority for many NHS IT leaders to support the move towards integrated care and providing patient access to their health records.
The reputation for integration work suffered significantly following the closure of the £12 billion National Programme for IT (NPfIT) in 2013 which had aimed to provide a shared, centralised electronic health record. Despite the delivery of some successful messaging projects such as e-prescribing, GP to GP transfers, Choose and Book and Personal Demographic Service (PDS), the programme resulted in a decline in integration projects for some years that followed.
Today, integration is not just on the agenda, it is top of it. The national chief clinical information officer has publicly stated interoperability is a top priority for the NHS.
FHIR® is five years old from whitepaper to publishing its fourth major version today, which is a short time for a standard. The time is right for adoption. But the NHS moves slowly, there’s not lots of integration projects, and people have day jobs.
There’s limited budgets, no time, and no national programme forcing change.
A bright outlook for FHIR®
Overall, the NHS has been quick to adopt FHIR®. Currently some NPfIT HL7 V3 interfaces are being redeveloped in FHIR®, and encouragingly newer interfaces are now being specified in FHIR® by default. Vendors are enthusiastic about the potential.
A lot of FHIR® is in development at a national level (England) and started with the first national level FHIR® project – the Female Genital Mutilation Risk Indication System 3. At a local level, investment in IT infrastructures, more open supplier interfaces/integration engines and a drive towards open data solutions are enabling better trust-wide interoperability, suggesting a shift towards further FHIR®-adoption. The UK in some respects is pioneering in this area: The King’s Health Partners (an Academic Health Science Centre) created a portal for clinicians in three hospital sites to view patient information in real-time. Within nine months, 50,000 requests to view patient records had been made. The project is thought to be one of the world’s first live FHIR® implementations.
Sustainability and Transformation Plans (STPs) and Local Digital Roadmaps (LDRs) programmes are driving the integrated care agenda and the formation of shared care records, the latter seen by many as unrealistic, and without adequate resource to deliver. As a result, specific FHIR® projects are growing in numbers, but there remains a reliance on government support and direction.
INTEROPen group, an action group to accelerate the development of open standards, was started by IT vendors, and now has arm’s length bodies and care organisations as members. Along with the Professional Record Standards Body4, the group has heavily influenced the adoption of FHIR® as a key standard – both organisations testing approaches to using FHIR® in practical scenarios in health. Recently, NHS Digital announced it will move to FHIR® standards for transfers of care to make sure provider systems can comply with the requirement to send structured, coded discharge summaries from hospital to GPs by 2018.5