From Theory to Practice: Bringing Healthcare Interoperability to Life

It’s not everyday that you participate in a community for the benefit of the greater good and end up being a direct beneficiary of that effort.  I’ve been fortunate to do exactly that — helping to realize the vision of an open, interoperable, and standards-based system that will improve patient care. This is my story.

– Yaron Derman, Director of Product, CognisantMD


Prior to joining CognisantMD, I spent a number of years as the Manager for eHealth Standards at eHealth Ontario. In this role, I came to believe that standards are a key enabler to better, faster, less expensive interoperability, which is what healthcare sorely needs to become truly patient-centred and data-driven. Unfortunately, there were very few examples to demonstrate the value of standards in practice.

It was during this time that the Ontario eServices Program (formerly the System Coordinated Access program) was looking for a standardized method to integrate eReferral systems across the province. The goal was to enable the Ontario eReferral ecosystem to scale across multiple vendors through plug-and-play integration to enable sending and receiving eReferrals.

At the same time, an emerging eHealth standard called HL7® FHIR® (Fast Healthcare Interoperability Resources) was gaining attention globally as the best hope for achieving eHealth interoperability. In my role as the Co-Chair of the Canadian FHIR Implementation Working Group, I proposed that an eReferral workstream be struck to allow vendors and jurisdictional representatives to help influence the direction of the eReferral integration specification.

The workstream, chaired by Tim Berezny (Caredove) and Caryn Harris (Orion Health), produced an eReferral API specification that has since been implemented in several eReferral systems in the province.

When I first joined CognisantMD, Ocean was not one of those systems.  Ocean could ‘speak FHIR’ through an integration engine and had proprietary integrations to over 15 systems in place, but it did not yet offer the FHIR APIs natively. However, as the Ocean eReferral Network grew, it became apparent that Ocean needed to natively support the HL7 FHIR eReferral APIs in order for the ecosystem to rapidly scale.

Here was a rare opportunity for me to study ‘in vivo’ whether the value of standards were just a concept or could actually be realized.   Would FHIR be easy to learn, fast to implement and easy to integrate with other systems?

I’m pleased to report that, from CognisantMD’s experience, FHIR absolutely lived up to these expectations!  After attending FHIR training, our developers were able to quickly learn how to utilize and implement the FHIR eReferral specification, and the core eReferral API and SMART on FHIR were developed within several weeks.

As I write this today, we have already seen the results of this work. In partnership with the Ontario eServices Program, St. Joseph’s Healthcare Hamilton recently announced the successful integration of the Ocean Platform with their Epic health information system, using SMART on FHIR. We are now in the process of integrating with additional systems in the same way.

From a product perspective, Ocean’s support for FHIR, SMART, SNOMED and LOINC unlock possibilities for broader integrations and downstream data usage.  The Ocean platform can enable a wide range of health-related eServices beyond eReferrals, including eOrdering, digital forms, and patient reported outcomes.  As we see more and more regions deploying Ocean eServices along with standards-based integrations, the opportunities to increase the ROI for health systems and vendors increase, because FHIR services can be developed more rapidly and the data can be leveraged more easily and broadly.

From a personal perspective, it is very satisfying to see my earlier efforts to develop a standards-based specification to enable eReferral interoperability coming to life in my current role. Standards are only as good as their ability to be used. The direction set at the jurisdictional level to leverage FHIR for digital health integration is a positive step towards achieving system-wide interoperability.

Ultimately, by eliminating silos in healthcare data, the benefits of that interoperability will flow back to the patients and providers, through a system that can provide better, more timely care.