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FHIR and interoperability: A journey to deliver value for all

With near universal digitization of healthcare in the U.S., enormous volumes of data are now available in electronic form. In order to be useful to clinicians and ultimately patients, that data need to be relevant, complete, organized, seamlessly accessible and actionable. These attributes are crucial to support effective and efficient care coordination, which is important given a growing aging population with complex healthcare needs.

CCDA may not be enough

While EHRs are ubiquitous, seamless data exchange to support patient care is not yet a reality.  The Meaningful Use program introduced interoperability requirements, notably the Consolidated Clinical Document Architecture (CCDA), included as a part of Meaningful Use Stage 2. The CCDA consists of nine document types for exchange between EHR systems.

While the CCDA has moved interoperability forward, the information may not be adequate for clinical decision-making.

Clinicians’ needs for information may vary based on a number of unique factors that may not be easily gleaned from these documents alone. Factors may be unique to each encounter but may include:

  1. Care setting—hospital, office, skilled nursing facility, home
  2. Patient complexity—number of chronic problems, number of medications prescribed, etc.
  3. Illness—acuity, severity
  4. Social determinants — health-related behaviors, socioeconomic and environmental factors

In addition to the EHR, a technology that can dynamically query relevant data, as well as organize, analyze and present that data seamlessly in a meaningful way that fits clinician needs and workflow would be a tremendous advancement in supporting clinical care and care coordination.

FHIR gaining traction

In recent years, the HL7 Fast Healthcare Interoperability Resources (FHIR®) standard has emerged. In short, FHIR is a means of transmitting health data from one information system to another though an application programming interface (API).

FHIR is rapidly gaining traction among a number of stakeholders, including the federal government, as well as payors, EHR vendors and pharmaceutical companies.

Here are some examples:

  1. Ninety-six percent of hospitals and 74% of clinicians have EHR systems with some FHIR API capabilities
  2. Centers for Medicare and Medicaid Services (CMS) developed the Blue Button 2.0 FHIR API to enable exchange of claims data with software applications, which can help make Medicare data more accessible to healthcare consumers.
  3. National Institutes of Health is encouraging researchers to explore using FHIR to “capture, integrate, and exchange clinical data for research purposes and to enhance capabilities to share research data.”
  4. Payors, including CMS, and providers are working together to automate data sharing using FHIR under the Da Vinci Project, which might reduce administrative burden by automating pre-authorization checking.
  5. Pharmaceutical companies are also active in FHIR development efforts, such as the use of FHIR to integrate clinical trial management with EHRs.
API to transform experiences                               

The U.S. federal government, through the 21st Century Cures Act, seeks to promote interoperability though API technology. More specifically, the Office of the National Coordinator for Health Information Technology is proposing that certified health IT applications use a specific API based on the FHIR specification.

In the commercial space, Apple’s Health App uses FHIR to connect numerous institutions to patients. The app allows receipt of health records such as vital signs, lab and radiology results as well as clinical documents—and I was even diagnosed recently with atrial fibrillation thanks in part to data from my smart watch. I was subsequently treated and able to download my clinic and hospital records to my smart phone. All through FHIR.

As FHIR continues to gain momentum in healthcare, the API experience will likely transform our experience with health information technology and mimic how we use apps in many other aspects of our lives. It will augment the EHR with nearly endless use-specific cases, such as preauthorization checking, aggregating health data from multiple providers, identifying care gaps in real time and delivering actional predictive analytics.

Getting to interoperability within healthcare remains a journey, but one that is rapidly advancing to help health IT more fully deliver value to caregivers and patients.

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