Alphabet (Google’s parent company), Amazon, IBM, Microsoft, and Salesforce have announced plans to support open standards for information sharing within the health care industry.
Currently, most medical records are stored in digital formats which are unique to each hospital or health care provider’s technology vendor of choice (think about the last time you went to the doctor’s office and they typed in information in a computer system in the exam room; if you go to another doctor’s office they may very well be using a different vendor, or even a customization of the same vendor’s system). This proprietary digitalization of data means that sharing patient data between facilities is difficult (perhaps even more difficult than when records were printed and stored in folders, at least these could be physically taken by the patient to his/her new health care provider).
To solve this problem, the aforementioned companies are proposing to build software tools which support the Fast Healthcare Interoperability Resources (FHIR) Specification, available here, as proposed by the Health Care 7 (HC7) non-profit.
Health care is therefore following a common path for technology industries. Initially, new technology tends to be closed and proprietary, with little interoperability among systems. As technology matures, the need is seen to have the various vendors of this technology interoperate with one another for information sharing or for other purposes. This need drives the development of new standards and specifications which define in an open way how systems should communicate with one another. Typically, the specifics of how a system works, such as programming language, internal data structures, and other details are left undefined; what is important is how the system exposes that information to the outside world and how it expects to receive data from others. Once systems can openly communication with each other, this also has the side effect of commoditizing the technology and therefore reducing costs over time.
This is the approach that HV7’s FHIR Specification appears to follow. From the overview document:
Healthcare records are increasingly becoming digitized. As patients move around the healthcare ecosystem, their electronic health records must be available, discoverable, and understandable. Further, to support automated clinical decision support and other machine-based processing, the data must also be structured and standardized… The basic building block in FHIR is a Resource. All exchangeable content is defined as a resource. Resources all share the following set of characteristics: A common way to define and represent them, building them from data types that define common reusable patterns of elements; A common set of metadata; A human readable part.
To summarize, health records may be stored internally by an individual vendor’s system in any number of ways. However, when it exposes this data to other systems, it must do so through the construct of a Resource which contains various data types and metadata which defines the resource.
Therefore, it is not enough to simply require medical records to be stored digitally. That was the first step in the health care information technology revolution and is largely accomplished. The next logical step is to make sure that these digital systems can communicate with each other to share information so that if a patient goes from his/her doctor to another doctor, to the hospital, or to a specialist, they can all easily retrieve the patient’s past medical history. It will also assist with the remote “tele-doc” type of services so that those providers can retrieve a patient’s information to aid in consultations.
Obviously, the tech companies mentioned above are not pursuing this path for altruistic reasons. Health care is a growing industry and is an area into which these companies, so successful in other areas, have not yet fully ventured (at least not to an appreciable degree). They all have strengths which they could leverage, ranging from search capabilities, cloud services, artificial intelligence, and contact information management. They’re looking to get a piece of the growing health care pie and see open standards as a way to break into this currently proprietary market.