Burning Down the Barriers to Data-Driven Healthcare in Asia
FHIR, the health data standard built for the Internet, is changing how clinicians, hospitals, and governments deliver healthcare. By enabling data-driven care, it promotes better outcomes, efficiency, and patient experience. Global FHIR expert Dr. Russell Leftwich from InterSystems writes about the new standard and its rapid adoption in Asia.
As populations live longer, medical treatments improve, and expectations for equitable access to care increase, demand for healthcare services continues to grow. With the global shortage of medical professionals, no country can meet the healthcare challenges and increasing expectations of an older population by maintaining a traditional approach to care provision.
At the same time, new diagnostic technology, including genomic sequencing, is creating exponentially increasing amounts of data, making new technologically driven approaches even more imperative.
Data-driven models of care and advances in technology like Generative Artificial Intelligence (GenAI) can and must bridge the gap to help clinicians be more productive and patients and their families more involved in managing their care. The Internet and smart devices have already revolutionized almost every other industry. Now, it’s healthcare’s turn.
Until recently, a key reason why we were held back was because health data is much more complex than other industries. One healthcare system could not readily understand and interpret the data held in another healthcare system. Now that we have a global Internet standard for healthcare data, HL7® FHIR®, those barriers are coming down, particularly in the Asia Pacific region.
FHIR Is the Same Technology as the Internet
Previous health data standards were created to connect two electronic systems together. They were designed before smart devices and the Medical Internet of Things came along. They were not built for the Internet like the application programming interfaces (APIs) that power the apps on our smartphones. On the other hand, FHIR, or Fast Healthcare Interoperability Resources, uses the same technology as the World Wide Web, so interoperating with these devices is also natural.
Probably the easiest way to explain FHIR is to think about a travel booking website. If you want to fly from Singapore to Bangkok on May 5th, in a few seconds, you can see all the flights on all the different airlines. It works because the airline industry has agreed on how to represent flight data – departure time, arrival time, and price. FHIR offers the same for healthcare. It is like a contract between systems about how to ask for the data and what you get in return.
FHIR is based on a flexible data model. It can be applied to an almost infinite number of use cases – financial, quality, supply chain, scheduling, etc. – not just clinical healthcare, to cover the entire healthcare system.
FHIR is also unique because it allows the same representation of data about an individual to be used in different interoperability paradigms. Because FHIR data is inherently computable, a data set obtained from a FHIR API can be used in messaging with another electronic system, in a FHIR document, or in clinical decision support.
Asian Governments Adopt FHIR for Digital Health
Because of this flexibility, FHIR is not interoperable out of the box. However, if you customize it for a particular use case by creating a FHIR profile, it becomes interoperable. Every country’s healthcare system has different use cases, and they can create and use their own FHIR profiles.
You could say each national healthcare system is a use case. Over 20 countries have created national FHIR Core Profiles, including the U.S. Core, U.K. Core, Japan Core, and Australia Core Profiles. These are high-level “national use cases” from which more specific profiles can be created for specific use cases in care delivery, public health, research, etc.
Governments across Asia Pacific have been quick to understand the power of FHIR. Indonesia’s national integrated health data platform SATUSEHAT, for example, has adopted FHIR to enable integration with healthcare providers’ electronic medical record (EMR) systems and with APIs for consumer healthcare apps. SATUSEHAT aims to remove the burden of patients taking their records to appointments, reduce duplicate testing and other wasted efforts, streamline service delivery, and improve Indonesia’s population health and genomics capabilities through large-scale data analytics.
Thailand, Malaysia, and Vietnam have also accelerated their digital health plans. Malaysia is deploying a national healthcare data lake around a common platform. Vietnam is planning to build a national platform for connected healthcare that includes interoperability between hospitals. While these countries have individual plans and approaches and are at different stages of digital health development, FHIR will play a key role in enabling interoperability between different systems and devices.
Unlocking the Power of Healthcare Data
InterSystems is heavily involved in implementing FHIR across the Asia Pacific region. For example, we offer the InterSystems IRIS for Health™ – Indonesia Edition data platform to meet the interoperability and data quality requirements for SATUSEHAT, easing compliance for healthcare providers.
Organizations implementing FHIR for the first time shouldn’t see it as a compliance issue but as an opportunity to unlock the power of their own data and get a return on their investment. InterSystems IRIS for Health also creates a repository of normalized, usable FHIR data so healthcare providers can perform advanced analytics and AI. Providers can connect the FHIR repository to medical devices, smart watches, mobile apps, insurance systems, and other data sources. Using their preferred data analytics solutions, they can gain actionable insights to improve patient care, experience, and engagement and streamline their operations.
Benefits of a FHIR Repository
Many people learning about FHIR assume incorrectly that a “FHIR enabled” EMR system has a FHIR repository. However, this is not correct. EMR systems typically use a FHIR API to convert data stored in the EMR database into FHIR resources on demand to a query. This is not the same as storing data as FHIR resources, as the IRIS for Health FHIR repository does, providing better performance, reduced processing requirements, and the ability to supplement FHIR data from multiple sources. You can’t add FHIR data to an EMR system.
The InterSystems FHIR repository also supports SMART on FHIR apps. These apps can do things like generate a pediatric growth chart on demand using the latest data or provide clinical decision support using FHIR resources stored in IRIS that may have come from multiple different systems, may have been converted from non-FHIR formats, or may have been generated from other apps, such as an app that captures patient-reported outcomes. This could help open up a whole app economy in countries where local EMRs don’t support SMART on FHIR, which was developed for the U.S. and is supported by EMRs built for the U.S.
Other benefits of the IRIS for Health FHIR repository include:
- Support for SQL analytics on native FHIR data in the repository
- Transformation of other health data formats, such as HL7 V2, to FHIR
- The machine learning (ML) and AI capabilities of IRIS, including Vector Search
Implementing FHIR Repositories in Japan
In Japan, InterSystems has helped to implement FHIR repositories at leading medical institutions. The country’s Intractable Disease Genome Project, for example, uses FHIR to coordinate questionnaires from consenting patients and capture their data from EMR systems at participating institutions.
A FHIR repository built on InterSystems IRIS for Health underpins a clinical decision support system at Osaka Metropolitan University. This repository captures and enables the analysis of data from multiple hospital information systems, including EMR and laboratory systems. At the University of Tokyo Hospital, an InterSystems FHIR repository maps injection orders from the hospital’s EMR system and an order app on clinicians’ smartphones with infusion pump configuration information for administering to patients.
Setting Australia and New Zealand on FHIR
InterSystems is a founding member of Sparked, an Australian FHIR accelerator that aims to deliver a core set of FHIR standards to facilitate electronic health data exchange. In a first for an Australian health jurisdiction, InterSystems is leveraging FHIR to help implement CSIRO’s Ontoserver in conjunction with a new EMR system in the Northern Territory. The Ontoserver FHIR API provides a simplified way to interact with complex structured clinical terminology products such as SNOMED CT-AU. This will improve day-to-day clinical workflows and facilitate future activities such as predictive analytics and research efforts. Such FHIR terminology services are also necessary in order to implement FHIR profiles.
Further afield, New Zealand’s Hira Programme is driving the move to use FHIR-based APIs so citizens can access their health information securely. InterSystems became an early user of the Hira Programme’s FHIR APIs while delivering the patient administration system (PAS) for Te Toka Tumai Auckland. The FHIR-based APIs make it possible to reconcile PAS data within the wider information systems environment. In addition to demographic information from the New Zealand National Health Index, for example, data can be exchanged with the National Enrolment Service about the doctor and primary care practice a patient is enrolled with.
AI Will Need FHIR to Acquire Vast Amounts of Data
A theme of many FHIR projects is capturing and analyzing clinical data independently from a single EMR or other healthcare system. Adopting this standards-based approach means far more data can be captured from multiple sources that represent data differently and then represent that data consistently based on FHIR. This will help to realize the benefits of AI and ML which will need vast volumes of clinical data to deliver the promised benefits to patients and clinicians. AI needs data in a standard format and in an interoperable state – using the same FHIR profile, for example – to represent data from different systems in precisely the same way. This is called semantic interoperability and is necessary in order to make reliable predictions, decisions, or recommendations.
FHIR also enables new data-driven models of care that provide better equity and access across the population or a more appropriate level of care for individuals with different conditions. For example, through the integration of healthcare apps and remote monitoring devices, FHIR enables care to be delivered to the community outside of healthcare facilities. This reduces the demand for resources that should be reserved for more acute and complex problems.
FHIR is already being used in Asia for community care. One of my former students and an attendee of my FHIR workshop, which I have delivered around the world, is now working for a non-government organization (NGO) in Indonesia. She is training community care workers on the use of FHIR-based apps for disease management. These workers are volunteers, not healthcare professionals, who help treat individuals in their homes. You can imagine the future potential to expand initiatives like this by connecting them to a larger healthcare data ecosystem like SATUSEHAT.
FHIR Provides the Foundation for Innovation
Because it is based on the technology of the Internet, FHIR has become the foundation for healthcare innovation that wasn’t possible with previous standards. It is a technology familiar to millions of young, tech-savvy individuals and represents a paradigm shift that we should all promote. With FHIR and low-code/ no-code data platforms like IRIS for Health, we can all be innovators and address our many healthcare challenges.
Jen-Hsun “Jensen” Huang, the CEO of AI chip company Nvidia, was recently quoted as saying that we should stop teaching our children to code because AI can do that for us now. That is an extension of the idea that we can all become innovators without having to write code. We can be innovators if we can identify and describe a problem, often one in our own workspace, and have a unique idea for a solution. And that is exactly what FHIR enables us to do.
Dr. Leftwich will be discussing the importance and evolution of FHIR in Asia at the InterSystems Asia Healthcare Summit on 21-22 August in Jakarta. Learn more about this event at:
