FHIR's purpose is an ambitious effort that defined healthcare standards and API's to accelerate development of useful web-like applications from Electronic Health Records (EHR). Project Argonaut is a private sector based initiative to build useful applications to drive adoption.
Applications for whom? The current applications are heavily internal EHR focused among multiple institutions and EHR vendors.
Although the industry talks about "patient centric" medicine, in reality that has as much relevance as "natural" has to foods you buy at the supermarket. Outside of a beauty contest called "patient satisfaction" there is not much in the field focusing on the patient's point of view.
And therein lies the killer app that can drive widespread adoption. Build an app that patients demand.
And it's not personal health records (remember Google Health?) Instead it needs to solve an immediate problem for a large number of people. I suggest an app that over 1 million new patients every year have a need for 3-6 months. That happens to be the number and recovery period for total hip and knee replacements (not partial, or repairs) in the United States.
There are evidence based protocols and procedures for optimal outcomes from surgery to full recovery over a multitude of care settings.
But who is coordinating this effort over the entire lifespan? Is it:
- The insurance company (or Medicare)?
- Primary care physician?
- Rehab center?
- Physical therapist?
All of those answers are incorrect.
In healthcare the presiding belief is that care manager is on the provider side of the house. In reality it is the patient or in many cases the patient's advocate. The patient advocate role could be the patient, significant other or a family member. Things get very complicated when the advocate is caring for Mom who lives three states away.
This is reality.
We need to build a post acute care platform with a FHIR component. But it goes beyond health records. This is the place that the patient advocate can coordinate, collect, manage and distribute information needed for the patient's full recovery (the use cases are numerous blog posts in themselves). Everything from medication reconciliation, getting DICOM images to the therapist, through hiring Task Rabbit to take Mom to the grocery store or find a plumber to fix the leaking faucet.
By moving the focus to the patient, several authentication and state issues can be avoided. Firstly, patients have access to their records regardless of the state involved. As for authentication, the patient has a key ring of OAuth tokens where their identity is confirmed by each medical provider or other entity. (it's signing into a new service using Google in reverse, where the patient is Google).
Create an application like this and FHIR will take off - Because the patient advocate will demand it.
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