4 min read

A FHIRside Chat with Moxe’s Chief Administrative Officer

As the long winter season approaches here at Moxe’s Wisconsin headquarters, there’s nothing quite as comforting as a nice FHIR (Fast Healthcare Interoperability Resources).


So, cuddle up with a cup of hot chocolate or tea, and settle in to read what our Chief Administrative Officer Mike Arce has to say about what has become the gold standard in healthcare interoperability.


Q: How would you define FHIR? 

A: FHIR is a few things, but best put, it is a format definition, rules and requirements for data elements, and an API definition that’s used to integrate data across the healthcare ecosystem. It’s the standard that looks to address many of the shortcomings of everything that came before FHIR, most notably HL7 V2 interfacing.


Q: What value does FHIR provide to entities who are sending or receiving healthcare data? 

A: The most valuable thing that FHIR provides is consistency. Sending and receiving data using FHIR means the data is standardized. FHIR allows organizations to receive data in a consistent, usable manner not only from Moxe, but also from all other data sources who make data available in FHIR. When data is delivered in a reliable, usable way, resources who were previously tied up cleaning data and making it usable are freed.  


FHIR can cut down on administrative waste in healthcare because those resources who were consumed with cleaning and packaging data can increasingly focus on tasks that provide more value to patients and other players within the healthcare ecosystem (think clinicians).  


Q: What value does FHIR provide to Moxe? 

A: Moxe can work with data in any format, FHIR and non-FHIR. We can deliver data in almost any format, and we work hard to meet our customers where they are to deliver data when, how, and in the form they need it.

When data is available in FHIR, all of us in healthcare tech can focus more of our efforts on making data not just interoperable, but actionable and usable. FHIR-centricity is our best opportunity to scale in the right way.

If we have to work with data in a million different forms, we can. But, the real value we can provide is in giving that data to our consumers and making it easy for them, and any tools they have, to use.


Q: In your opinion, does FHIR have any shortcomings?

A: Of course, but as I said before, it’s the gold standard! FHIR, along with the United States Core Data for Interoperability (USCDI)a standardized set of health data classes and constituent data elementshas been overwhelmingly positive for healthcare interoperability. Nothing is perfect, and we’re seeing some of the same issues with FHIR that we saw with HL7 V2 and reverting to some of the bad habits we’ve had with other integration standards. 


First, FHIR doesn’t address the infrastructure problems that exist everywhere across healthcare. Until we clean up data at the source, we still need lots of people looking at how to map data and troubleshooting why data isn’t mapping correctly. Exposing data in a consistent manner means the data has to be standardized somewhere. In some EHRs, for example, data looks different on the backend for every customer. Someone needs to make sure data is standardized before it gets to, or within, the FHIR server. That’s an incredibly laborious process, especially if it needs to be done for every customer.


A second shortcoming of FHIR is the use of extensions. The allowance of extensions can make the simple standard more usable, but can also make things more challenging. Extensions are easy, and as the standard evolves, pose an option to make quick and simple changes that can have long term impacts if implementations of FHIR don’t evolve as the data evolves. Extensions should be used for the intended purposes only: to communicate additional information not already included in the resource definition, and not just as the easy button.  


Finally, privacy and security are, and will continue to be, concerns for constituents working with FHIR. While FHIR breaks down data into small increments, there are nuances within the increments and restrictions that should be considered whenever exchanging data. Check out the SHIFT Taskforce to learn more about how an independent group is tackling the privacy-side of this conversation. 


Despite FHIR’s limitations, I do want to reiterate that I think it’s overwhelmingly positive for healthcare interoperability. 


Q: In the age of FHIR, what value does Moxe continue to provide? 

A: Many of our customers want us to provide them data using FHIR for the same reason FHIR is valuable to us: It’s consistent. 


In an ideal world, every system or application sending and receiving healthcare data would do so using FHIR. That’s not the current reality.


Let’s look at an example: Perhaps a health plan has developed a central data lake that serves all apps across the health plan’s operations. If data is made available to that data lake in FHIR and persisted in FHIR within the lake, then all consuming apps just need to “speak” FHIR and things should be fairly straightforward to integrate. Now, if any of the data is received in a non-FHIR form, or persisted differently, then someone has to manage how to make that data usable. Also, assuming some of the systems using the data in the lake are not capable of working with FHIR, then that integration will have to be separately managed. Multiply this across every health plan and every application, and it’s a real problem. Having a partner like Moxe to help manage this at the point of ingestion and a simple way to manipulate the data in the lake would allow 2-3 people to do the work of what 20-30 do today.


In short, the value we provide is this:

Whether data comes in FHIR or not, Moxe makes it usable and packages it however our customers need it. 

Q: How do you hope FHIR evolves and is used in the future? 

A: Moxe is working to do more with FHIR every day, including using it as a core piece of our data platform. When your core data language is FHIR, everything you do will “speak” FHIR. 


Ideally, every app and solution in healthcare would use FHIR so that incoming data is in FHIR and all ingestion points for data are in FHIR. That’s where we’ll start to see huge gains and the real promise of interoperability in healthcare.

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