HL7

What is HL7®?

  • Health Level Seven International, which is known as HL7, is the not-for-profit global authority for health care information interoperability and standards with a focus on clinical and administrative data.
  • HL7’s mission is to provide standards that empower global health data interoperability.
  • HL7 is supported by members from over 50 countries, including over 500 corporate members representing healthcare providers, government stakeholders, payers, pharmaceutical companies, vendors/suppliers and consulting firms.
  • HL7 is dedicated to producing comprehensive frameworks and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services.
  • Learn more at www.HL7.org.

What is HL7 FHIR®?

  • HL7 FHIR (Fast Healthcare Interoperability Resources) is a contemporary industry standard API (application programming interface) and data model that supports exchanging healthcare information electronically.
  • FHIR provides a consistent, easy to implement mechanism for exchanging data between healthcare applications that can be used as a stand-alone standard as well as with existing widely used standards.

FAST

What is FAST?

  • FAST was launched as an ONC-convened initiative in late 2017 in response to an industry-recognized need to address shared FHIR scalability challenges.
  • FAST brought together a highly representative group of healthcare industry stakeholders and health information technology experts who worked collaboratively to:
    • Identify key FHIR scalability infrastructural challenges
    • define the core capabilities that cut across those challenges,
    • develop solutions to effectively address them.
  • As it transitions to an HL7 FHIR Accelerator, FAST’s mission continues to be the development of core solutions that contribute to an infrastructure that supports scalable FHIR solutions.

Where other FHIR Accelerators are focused on building functional use cases to overcome specific data exchange barriers, FAST is focused on addressing underlying barriers that threaten the scalability of those functional use cases such as:

    • Identity (digital identity & patient matching)
    • Security (scalable registration, authentication, and authorization)
    • Directory (FHIR endpoint directory with validated/attested information)
    • Exchange (hybrid/intermediary exchange routing)
    • Testing & Certification (certification standards)
    • Scale via Intermediaries (scaling requirements for FHIR RESTful exchange in a hybrid environment)

What is it not?

  • FAST is not building specific software products or tools but instead will deliver standards (implementation guides) that software developers can follow to avoid having to solve common barriers for each implementation project.
  • FAST is not working on functional use cases but rather focused on infrastructure

Why is FAST important?

  • FAST’s work is critical to scalable FHIR solutions
  • The infrastructure envisioned by FAST smooths the path to implementation of all FHIR Implementation guides by solving for critical barriers that may have barred some stakeholders from even considering FHIR adoption.
  • Scalable FHIR solutions leads to more ubiquitous FHIR adoption to support real-time, secure data exchange between the right stakeholders at the right time.

What problems does FAST solve?

  • While FHIR is as secure as other standards, there is no designated framework nor convening organization to make security more scalable and reliable across all implementations.
  • There is currently no standard to support the consistent and reliable confirmation of patient identity in every transaction.
  • As more stakeholders are standing up FHIR servers and implementing FHIR implementation guides, there is no central place for stakeholders to find existing FHIR endpoints in a secure, automated way or to know what version of FHIR is being used by that endpoint.
  • Data within the US healthcare system is exchanged in a hybrid environment, some data may be exchanged directly point to point and some data may route through an intermediary, but all data needs to be seamlessly exchanged.
  • Leveraging FHIR in a scalable way will help to reduce manual efforts that are still employed while automating workflow and providing data in a timely manner.
  • Lack of interoperability limits many stakeholders in the healthcare community from achieving better care at lower cost ultimately impacting the patient’s experience and creating more burden for all.
  • Delays in implementing the implementation guides coming out of HL7 Accelerators and Work Groups because of scalability challenges means that real-life use cases, including prior authorization and identifying gaps in care and others being driven by regulations aren’t being meaningfully addressed.
  • The FAST Steering Committee will consider taking on additional work as new challenges and problems arise

What are the benefits of FAST?

The FAST Accelerator:

  • Convenes industry to efficiently consider and evolve consensus-based approaches to common foundational components.
  • Advances transparency and interoperability, creating an environment where FHIR implementation is scalable which, in-turn, facilitates easier sharing of health information across the healthcare ecosystem.
  • Leverages the collective expertise and efforts of industry experts and internationally recognized exchange standards to solve problems.
  • Saves money by minimizing the need across industry players/ stakeholders to address over and over again common implementation barriers encountered in most projects.
  • Recognizes that intermediaries and other health tech vendors are providing services to key healthcare stakeholders and their needs & perspectives should be built into the infrastructure.

Why now?

  • Healthcare is moving toward true interoperability and the use of APIs, with FHIR being a major player in this progress bridging and extending existing standards-based investments in use today.
  • As FHIR is named in more regulation, creating an environment where it can be implemented in a scalable way becomes more critical.
  • The ONC issued a proposed rule (21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program) in February 2019 stating it intends to make FHIR a requirement for developers participating in the ONC Health IT Certification Program.

How is it different?

  • FAST’s work is critical to support the scalability and wide-spread adoption of all the functional FHIR use cases.
  • Unlike the other FHIR Accelerators, FAST began as an ONC-convened initiative as the result of industry pressure to address the infrastructure barriers to scalable FHIR solutions.
  • Much of the foundational work has been done and the transition to a FHIR Accelerator will allow FAST to execute against the roadmap that has already been established and change course as the industry requires through the new governance structure.
  • Whereas functional use cases are many times focused on reducing administrative burden of clinical workflows, FAST’s work can reduce the friction during the implementation of use-cases AND positively impact clinical workflows.

Why does it work?

  • Leveraging HL7’s successful track record of standards-based work, FAST has a dedicated team of thought leaders from providers, payers and technology vendors who are working together to put forward and use standards that solve infrastructure barriers to promote scalable FHIR solutions the enable data exchange in real time.
  • The collaboration of competitors working toward interoperability is leading to success. It is an open process, and the world is participating.
  • Having the right team and a governance model that gives everyone a fair voice at the table to drive priorities are key elements of FAST’s governance.
  • FAST identifies the organizations that want to be change agents, leverages their best subject matter experts to solve existing business challenges, and hires the best and brightest from the standards community to execute and create the standards.

What are the types of projects?

Projects currently on track for balloting or have been recently balloted:

  • Security for Scalable Registration, Authentication and Authorization
  • Interoperable Digital Identity & Patient Matching Capabilities
  • Hybrid/Intermediary Exchange: Exchange with or without Intermediaries
  • FHIR Endpoint Discovery
    • National Directory – Exchange (i.e., update the Validated Healthcare Directory (VHDir) for US Realm)
    • National Directory – Endpoint query
    • National Directory – Attestation and Validation

 What are a few examples? 

  • The Security for Scalable Registration, Authentication and Authorization leverages security work done disparately across the industry and puts it together into a comprehensive solution to help improve the ease and confidence of securely exchanging healthcare data.
  • The Interoperable Digital Identity and Patient Matching Capabilities implementation guide provides a roadmap to consistent and confident verification of patient identity across organizations, working within the current systems while the future solutions are being considered as systems mature and capabilities increase.

FAST Transition to Accelerator

What is FAST aiming to accomplish as an HL7 FHIR Accelerator that the existing volunteer workgroup cannot or has not?

  • The FAST volunteers have accomplished a great deal of work and we thank them for their continued efforts and contributions!­
  • FAST was launched as an ONC-convened initiative in late 2017 in response to an industry-recognized need to address shared FHIR scalability challenges.
  • FAST has evolved from identifying needed core capabilities and establishing conceptual solutions to now doing the standards development work to ready the solutions for industry implementation and adoption. This standards work naturally aligns with the HL7 FHIR community which was a driving factor for this transition.
  • FAST, as an Accelerator, will continue to develop core solutions that contribute to an infrastructure that supports scalable FHIR adoption.
  • In addition to standards development, the FAST Accelerator will focus on facilitating testing and implementation of FAST standards/solutions.
  • As FAST transitions to HL7, ONC is calling on the industry to continue supporting FAST by actively participating in the Accelerator, contributing thought leadership and expertise, and adopting FAST solutions.

My organization does not have the funding available to pay for HL7 FAST membership. What are my options?

  • As an HL7 FHIR Accelerator, FAST provides many opportunities for the public to participate through the HL7 standards development process
  • All people and organizations are encouraged to participate in whatever capacity they can whether:
    • participating in public calls
    • providing input into FAST implementation guides as they are developed
    • testing FAST solutions through HL7 FHIR Connectathons,
    • providing feedback as FAST standards are balloted

What options do provider/health system organizations have for membership if they want to participate in governance of the Accelerator?

  • All paying members will receive one voting seat on the FAST Operating Committee.
  • Organizations at the Premier membership level are eligible for a seat on the FAST Steering Committee.
  • Membership levels other than Premier will also be considered eligible for Steering Committee membership depending upon the need to provide balance on the Steering Committee.
  • The Steering Committee makeup is currently slated to include 2 seats for Payers, 2 seats for Providers, 2 seats for Tech/HIT Vendors, and 4 at large seats (in addition to appointed seats for HL7, ONC, and CMS).

  What future projects are under consideration for FAST?

  • Once formed, members of the FAST Steering and Operating Committees will prioritize and set direction for future projects.
  • Projects for future consideration may include:
    • Methodology for supporting multiple production versions of FHIR
    • Scaling requirements for FHIR RESTful exchange in a hybrid environment
    • Testing and certification
    • Consent
    • Others as proposed by the FAST Operating Committee






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