Table 3.
Quotes supporting enabling force themes.
| Recommendation / Potential Driving Force | |
|---|---|
| Research funders requiring FHIR | I think that they’ve gotten better about when their reviewers [research funders] are reviewing proposals looking at how generalizable is this, right? Are they using standards that can be used outside of Epic or Cerner …is this something that’s going to ultimately be shared outside of the organization where it’s being developed, so it’s not a one off? (Expert 4) |
| CCDS “App store” | There are not a lot of tools built on top of FHIR. We are working on number of projects where we’re using FHIR questionnaire resource … I don’t want to invent builder or player for questionnaire… there are a number of open-source half-baked tools to build questionnaires, none of them are great... for FHIR to evolve faster … people should build more tools that you can use with FHIR as a kind of underlying plumbing … for product purposes (Expert 1) A marketplace is the idea where I can go store something or sell something… It can’t be single platform or single EHR specific. Marketplaces have to be EHR agnostic. CDS Connect is a valiant effort to move along these lines, but it’s not a commercial entity. (Expert 3) The analogy is over worn, but I can buy any calendar program for my iPhone and if I don’t like it, I can swap it out for the other one … it’s the idea of this marketplace being very effective. They already installed the EHR, but they should allow us to do more on top. (Expert 3) |
| Clinical organization incentives | … a monetary incentive to the customers of the EMR. Then it’s really the customers that had to go say hey, if you want to continue with my business you need to make this work. I think all the EMR’s responded to that very quickly. (Expert 2) It takes organizational commitment … everyone is in such a rush, and it’s hard to take the time, to do what you need to do whether that’s educating your workforce, sending them to training … then actually looking at your systems and saying OK where can we integrate these standards and what’s the process for swapping out what we’re currently doing currently … coming up with a road map. That all takes time and education and lots of money. I think we need some incentives to support organizations to do that sort of thing. (Expert 4) FHIR apps that are targeting very specific clinical decisions or very specific outcomes for which there’s a significant financial incentive … I don’t know if the calculus changes in that space (Expert 5) It may improve quality in some way, it may improve outcomes, it may improve guideline adherence in some way. That may be great, but the benefit, the direct benefits, do not accrue to the organization. They accrue to the patients, which is fantastic… when we come down to making implementation decisions, it’s harder … if these implementations mean less money or the same money as we might get without them or what we might get with the native functionality of our ER versus some third-party app. (Expert 5) |
| EHR vendor incentives | I’d say that … EHR vendors should more aggressively … adopt the latest versions of the standard. That would develop more flexibility in decision support and make it much more efficient and much more effective. That’s the most important thing …is actually adopting the latest evolution of the standard. (Expert 1) I think the inability to do it [support FHIR], I think was probably was the push …saying this could become a decision point for sites [choosing an EHR] (Expert 2) You must have APIs that at least meet this set of FHIR resources or comply with this set. I think continuing to push on those so that vendors must be open. (Expert 5) |
| FHIR certification | If there was some authoritative body like an HL7 … but where I could send our staff to get up to speed and maintain with some regularity credentials around these standards. Yeah, I think that would be valuable. (Expert 5) |