A recent blog post by ONC highlighted some amazing analysis around the adoption of FHIR® in US. The post briefly mentioned how Apple, Google, Microsoft and Amazon are planning to leverage the HL7® FHIR® standard. Earlier last year, Google, Microsoft, IBM, Salesforce and Amazon issued a joint statement at the 2018 Blue Button 2.0 Developer Conference -
“We are jointly committed to removing barriers for the adoption of technologies for healthcare interoperability, particularly those that are enabled through the cloud and AI. We share the common quest to unlock the potential in healthcare data, to deliver better outcomes at lower costs.”
In this blog, we are going to review how some of these large tech companies are approaching FHIR.
Although Amazon supports “HIPAA Compliance” for it’s cloud platform, Amazon hasn’t announced any FHIR® specific offering yet. However, Amazon does provide “Platform as a Service (PaaS)” for healthcare IT vendors to implement FHIR® based solutions. There are a lot of open source FHIR® implementations available that developers can use to configure and mange a FHIR® instance on the Amazon Web Services (AWS).
While Google and Microsoft also offer multiple “HIPAA Compliant” options for Platform as a Service for hosting FHIR, both the companies have also developed FHIR® specific solutions offered as Software as a Service (SaaS). Both the SaaS solutions are based on the currently most widely adopted STU 3.0 version of FHIR.
Google announced their “Cloud Healthcare API” last year. Cloud Healthcare API provides a managed solution for storing and accessing healthcare data in FHIR format. In simple words, it allows you to spin up a FHIR server hosted on the Google Cloud Platform in minutes and start developing FHIR based solutions. The API implements every single resource in the HL7® FHIR® specification and its related operations. However, I think the key differentiator of the Google Healthcare API is the support for HL7 V2 messages. Google’s API supports out of box conversion from Version2 messages to the FHIR standard, which could be huge for integration with legacy systems. Google Healthcare API is currently in Alpha phase and is only available under an early access program.
Microsoft has taken a radically different approach to FHIR. Late last year, they announced an open source project for developing a FHIR server. The project is available on GitHub. It already has a very active community being supported by the Microsoft engineering team. I have been following it from day one and it is really amazing the pace at which new features are being developed and released in that. It uses Microsoft’s Azure Cosmos DB as the data persistence layer. Microsoft’s FHIR service is not available as a standard Azure service. I am guessing it probably will be in near future. The GitHub documentation does include an “easy button” that deploys FHIR Server for Azure into nearly any Azure public region.
Update: Microsoft announced Azure FHIR API on 2/8/2019. Read more about it here
While Microsoft and Google are targeting healthcare providers and software vendors with their cloud FHIR offering, Apple is bringing FHIR to the healthcare consumers. Apple announced a FHIR® feature as part of its Health App. This feature allows users to download their data directly onto their iPhone from healthcare organizations that support FHIR AND have integrated with Apple. By bringing FHIR directly to consumers, Apple is creating a demand that will hopefully further accelerate the adoption of FHIR by healthcare organizations. The downloaded data is available as part of Apple’s HealthKit for developers to embed in other apps. However, this access is “ready only” and there is no way to add new data, other than from the organizations that have integrated with Apple. Also, Apple is currently only supporting 8 resources, compared to over 100 resources that are currently available under FHIR. This combined with the fact that it is available only on iPhone (not even on iPad) is a serious limitation.
Over the last few months, we has been working very closely with the alpha version of Google Healthcare API, the open source Microsoft FHIR® server, as well as the FHIR components of Apple’s HealthKit to develop a prototype solution that can be leveraged by various types of healthcare organizations. In the follow-up blogs, I will do a deep-dive and discuss our hands-on experience with each of these offerings and how you may be able to leverage one or more of these in your FHIR strategy.