Epic provides support for these standards. https://fhir.epic.com/
Like Zigbee, in theory like every company supports it but in practice moat imlementations is not compatiable with each-other
Now, how much they share is potentially open to debate.
Using FHIR means syntactically interoperability. Same structure, uses json, things generally in the same place.
Semantic interoperability means that the 2 systems can understand each other… just using FHIR is NOT enough for this. Different value sets and ways of representing the same information mean that 2 systems view of the same data may be very different.
I liken this to when I walked into a bar in a small town in Northern Ireland. I was speaking English, the bartender was speaking English, but we could not understand each other. We eventually figured things out but it was TOUGH to communicate even though we were ostensibly speaking the same language.
This is what FHIR apis from 2 different vendors are like. Same “language” remarkably different dialects
They still require massive amounts of implementations.
For example, condition in the US is likely to use ICD-10. Procedures, especially those billed are going to use CPT or HCPCS.
Any person working in healthcare software, which I did for 15 years, knows that for every standard there is a myriad of vendor implementations, bugs, hacks, workarounds, and just saying "System A speaks FHIR and System B does too" does not mean you can just load an EHR dataset from A into B and have all the information usable.
It looks like a VB app from the 90s. Text layout is poor, often overflowing boxes, it's not customizable.
Epic is where it is because hospitals are so fucking locked in.
I’m rooting for something like this in the long term: https://github.com/openemr/openemr
I desperately want it to gain some real traction.
Working in the enterprise world, including the enterprise healthcare world... it's not "right", but as long as it exists as a PHP webapp...
I don't see that happening. No matter how good a PHP webapp it is.
I really want it to succeed. But there is so much further to go. For example, on the subject of backing up your EMR data, there is this:
> Disaster can strike at anytime. Backing up will mean the difference between a mild inconvenience and a major imbroglio.
> Choose a method according to the operating system from this webpage.
> Windows users are advised not to rely on the built-in utility once their file size becomes too large. The reasons are discussed in this Forum thread.
That's it?? That's the extent of your backup discussion for a business critical application storing PHI? Oof.
Any CIO remotely considering OpenEMR, even one hugely cost-constrained, is going to run for the hills.
That said, lots of the problems with Epic is it is used so differently between hospitals/installs. It's less a EMR + scheduler + hospital management app than a toolkit used to construct those for big enough medical companies. That inevitably doesn't lead to nice software: see all enterprise software everywhere.
Source - I design medical devices
The two hospitals on Epic are great - all of her records are immediately exchanged. The third hospital has a shitty cerner system and has problems sharing between departments. The cancer center has an excellent patient portal but doesn’t integrate.
Ultimately these problems are difficult as the creation of Medicare and Medicaid happened during the early days of computing. So we’re stuck with 75 years of legacy.
I'm a software engineer, so I ended up creating my Personal Health Record (PHR) application, which I eventually open-sourced - https://github.com/fastenhealth/fasten-onprem
It's still a work in progress (and definitely not ready to be used as the primary source-of-truth), but I'm always looking for actionable feedback/contributors. I'd love to hear your thoughts
We're getting there quickly with FHIR!
Hopefully with the Cures Act Final Rule, interoperability will become the norm
People had a fit over Windows in the 90's and 2000's being proprietary lock in, but it was never the OS that was the problem, it was MS Office format lock-in that caused all the issues, which is still a problem.
Open, simple, interoperable formats are the way out. We need more of these, especially in the health care sector.