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EHR vendors, tech-savvy providers unite around Internet-like interoperability

Five major electronic health-record system developers and four information-technology pioneer provider organizations have formed an alliance to promote a new, Internet-based approach to interoperability and clinical information exchange. 

“It brings Facebook-, Google- and Amazon-like thinking to healthcare IT,” said physician informaticist Dr. John Halamka, chief information officer at Beth Israel Deaconess Medical Center, a participant in the alliance. 

“This is also an initiative that is saying the industry can take the lead on this stuff now,” addressing the need for improved health IT interoperability without government prodding or control, added Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, a health information exchange organization.

The newly announced Argonaut Project will be managed by Tripathi’s collaborative. The initiative was launched by healthcare-IT standards development organization Health Level Seven (HL7) with EHR vendors athenahealth, Cerner Corp., Epic Systems and Medical Information Technology (MEDITECH) and McKesson on board. The five developers control about 45% of the hospital market and 28% of ambulatory care market for complete EHRs, according to data released by the federal EHR incentive payment program this spring. 

Joining them are tech-savvy providers Beth Israel Deaconess and Partners HealthCare, both based in Boston; Intermountain Healthcare in Salt Lake City and the Mayo Clinic in Rochester, Minn. Also participating as founding members are the Washington-based consulting firm The Advisory Board Co. and the federally funded SMART (Substitutable Medical Apps, Reusable Technology), a mobile application development project at the Boston Children’s Hospital Informatics Program

These founders have pledged to promote the accelerated development and adoption of HL7’s new health IT standards framework, called Fast Healthcare Interoperability Resources, or FHIR (pronounced “fire”). The FHIR platform debuted earlier this year at the annual Healthcare Information Management and Systems Society convention. 

The private-sector initiative won praise from HHS’ Office of the National Coordinator for Health Information Technology. “It’s great to see this collaboration step up and we look forward to its success,” said Steven Posnack, director of the ONC’s office of standards and technology.

Much of health information exchange today, including that required by the federal government in its EHR incentive payment program, is based on moving static, electronic documents—such as care summaries—from one provider to another, Halamka said.

Instead, Halamka said, “Imagine Epic and Cerner and athena had a hook on their EHRs.” And that hook, called an application programming interface, or API, could be accessed by developers of other brands of EHRs, or used as a link point by hundreds of outside mobile application developers. The hook could enable both the EHR and the mobile app to not only read data from each other, such as lab values or care plans, but also write data back to each other, in formats that each system could display and compute. 

“That’s a different kind of enabler than sending a package of information from place to place,” Halamka said.

The Argonaut Project takes its name from crew members led by the hero Jason in Greek mythology. It also refers to the recent work in healthcare IT of JASON, an independent group of scientists that has produced two reports for HHS’ Agency for Healthcare Research and Quality on health IT interoperability. 

The JASON group recommended that HHS promote a different architectural approach to health information exchange based on Internet development principles. Specifically, it said HHS should leverage the federal EHR incentive payment program to mandate development of a new “architecture” for health information exchange based on APIs. 

The Jason report task force, an HHS advisory panel, recommended in October that FHIR “is currently the best candidate API approach to data-level and document-level access to healthcare data.” 

The Argonaut coalition was formed at a dinner meeting the evening after the task forces’ Oct. 15 presentation to a joint session of two federal healthcare advisory committees, said Dr. David McCallie, president of medical informatics at Cerner, who, with Tripathi, served as task force co-chairman

Having vendors and providers collaborating with HL7 “will ensure that the API gets written the right way,” McCallie said. 

The goal is to have a healthcare IT platform similar to the Apple and Android platforms for smartphones and tablets, McCallie said. Some of the capabilities come from apps written by the developer of that platform and are supplemented with apps and plug-ins from outside developers. 

“As we go to market today, especially with the larger IDNs, they want to make sure they’re not locked into the capabilities that only the developer has created, McCallie said. “It’s the way the rest of the industry has moved and healthcare can’t ignore it.”

Halamka said he foresees participating providers will have some FHIR-based pilot projects developed next year, with HL7 delivering a formally balloted draft standard for trial use in May. That will include both FHIR-appropriate health IT standards and an implementation guide, which developers can use to create products, such as mobile apps linked to EHRs using a standardized API. 

“I expect to see some mainstream products by 2016,” Halamka said.

Follow Joseph Conn on Twitter:@MHJConn

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