For health plans, hospitals, and health systems, 2020 will likely be remembered as the year of the customer, or the year of greater consumer influence. The governing authorities have been pushing for more interoperability and price transparency of drugs and hospital costs driven by customer demands. As healthcare awaits an industry-defined data model that is pragmatic for business-critical analytics and outcome improvement, fast healthcare interoperability resource (FHIR) has emerged as one of the leading drivers in healthcare information exchange.
FHIR is a standard describing the data formats, elements, and APIs for exchanging health information on electronic health records (EHRs). Created by Health Level Seven International (HL7), FHIR leverages previous HL7 data format standards and uses a modern web-based suite of APIs for inter-communication among payers as well as between payers and providers.
The Office of the National Coordinator for Health Information Technology (ONC) has a 10-year roadmap (2015-2024) with an objective of achieving nationwide interoperable healthcare. However, the momentum for institutionalizing interoperability by payers and providers has taken a significant leap only after the finalization of ONC’s Cure Act Final Rule in March 2020.
ONC’s Final Rule helps patients be in charge of their health records, leading to transparency in care costs and outcomes through third-party mobile apps along with competitive options in getting medical care.
Some of the significant interoperability themes that have put FHIR as a promising venture in this space can be outlined as follows:
Technological advancements help consumer engagement with relevant data and simplified access.
Data is key and digital transformation with latest technology and modern standards will help create innovative solutions for consumers, providers, and payers.
FHIR does not solve all healthcare IT interoperability needs, but it provides the much-needed foundation for digital themes that drive business value.
It is essential for both payers and providers to enhance the initial implementation of the FHIR service once the federal requirements are met. Accordingly, complex use cases require data from more sources, and FHIR will require not only a broad adoption but a change in the culture of data sharing, thereby increasing outreach to new customers. Beyond the initial setup, point-to-point projects must expand quickly, and organizations should work towards simplifying processes, such as data acquisition and publishing data from an EMR. Expanding beyond an organization’s IT ecosystem requires that data trading partners have a comparable readiness level.
Payers: Things to Consider for Implementation
Achieving and sustaining data-driven healthcare improvements with FHIR relies heavily on the technical readiness of the vendor and partner systems, as the vendor community is a partner in this FHIR ecosystem. Payers on their part are required to establish the following to meet the Rules’ requirements:
Implement an FHIR platform to expose APIs for data access by patients
Integrate the core System of Records to the FHIR platform
Map the source system data to FHIR standards and vice-versa
Implement SMART framework on top of the FHIR platform for integration to third-party apps
Implement OAuth2-based Identity and Access Management for data access by patients
Ensure patient consent management
Acquiring the technology and skills to implement and maintain the FHIR solution could be a multiyear effort. FHIR provides an alternative to document-centric approaches by directly exposing discrete data elements as services. Some of the basic components of the healthcare value chain, like patients, admissions, diagnostic reports, and medications can each be retrieved and manipulated via their own resource URLs.
From an industry standpoint though, compliance is one of the immediate needs for healthcare organizations, mainly payers and then for payers with providers but the road ahead should be controlled, comprehensive, and cohesive. In the compliance stage, organizations will focus on payer-to-payer integration followed by payer-to-provider, along with patient data access.
In the controlled stage, governance is enforced along with the maturity of the interoperability services beyond the walls of the healthcare organizations. Care coordination and portability of the services are the key areas for organizations to emphasize on, where the consumer or customer is the central focus and there is a true rise in on-demand healthcare.
In the comprehensive stage, the interoperability model reaches a matured stage where a distinct and clear picture is provided to all stakeholders, starting from enrollment services to the realization of care. Things like prescriptive analytics come in to play where all guesswork from the decision-making process is removed and thereafter, it is optimized to provide more improved care to patients.
The healthcare industry stands to benefit massively by adopting the FHIR paradigm. While federal compliance pressures may cause some short-term challenges, organizations must prepare with an adoption strategy that looks beyond the initial push for compliance and accommodates complex use cases that require more partners, more connections, and more time.