Interoperability Innovation Whose Time Has Come

In summer, 2018, we were “Hot on FHIR” and we continue to see the growing value and potential that FHIR — Fast Healthcare Interoperability Resources – is yielding.

An article in Healthcare IT News quoted Dr. Russell Leftwich, “Interoperability is changing. It’s no longer about connecting two systems inside the hospital to each other. It’s about trying to get all the data for an individual in real time, the way we’re used to in other domains.”

FHIR (v3.3.0) is, essentially, an API – a RESTful, open API standard. It bridges interoperability gaps between disparate systems – FHIR can create seamless communication between providers, payers and others who are engaging in value-based care.

According to Dr. Leftwich, FHIR has been “more successful than anyone thought it would be. “Unlike previous standards, where people waited to see what it’s going to be like, with FHIR, people have taken it and run with it.”

Since our last article, organizations, initiatives and the government have made significant commitments to FHIR:

  • Launched in January 2018, the Argonaut Project is a private sector initiative to develop FHIR-based APIs and promote the standard as a way to solve many of the provider community’s most challenging use cases. Thirteen leading organizations are project sponsors, including Cerner, Epic, athenahealth, MEDITECH, and McKesson.
  • Also in January 2018, the Da Vinci Project is focused on the needs of the value based care community, addressing two use cases this year amongst several contenders, including 30-day medication reconciliation, coverage requirements discover, authorization support, eHealth record exchange in support of HEDIS/STARS and clinician exchange.
  • At HIMSS in March, the VA announced the beta version of their Lighthouse Lab initiative that allows health IT developers to connect to data assets through application programming interfaces (APIs). This piece highlighted, “The VA intends to begin building out the platform by making the common clinical data set available, but will also work concurrently on other FHIR resources, including elements that will enable applications related to scheduling, patient encounters, patient feedback, and clinical documentation.”
  • Also at HIMSS, former VA Secretary Shulkin touted organizations who have signed the VA’s Open API Pledge, including 11 organizations to date — Cleveland Clinic, Geisinger, Intermountain, Mayo Clinic, Partners HealthCare, UPMC and others. They are promising to map data to “industry standards including the current and forthcoming versions of the Argonaut Project specifications of FHIR API over the next 18 months.”
  • Lastly, Google launched its Cloud Healthcare API, utilizing FHIR, at HIMSS18.
  • Just this month (April, 2018), Apple launched features to its Health app, enabling patients at participating U.S. hospitals and clinics to access their medical records from multiple providers on their iPhones. These major providers include Cedars-Sinai, Johns Hopkins Medicine and Penn Medicine and over 40 others.

Yet, there are bumps in the adoption path:

  1. Most app development firms are not well-versed in the intricacies of medical data and clinical workflows.
  2. The goal isn’t just about connecting data amongst systems, but interweaving knowledge about the patient or member’s environment, daily activities and behaviors found in the medical data.
  3. The potential of FHIR can be found when interoperability teams are expert in a wide variety of data types — different EHR systems, settings and sources.
  4. Change management, adoption, and creating business rules that can address compliance needs, as well as privacy, and security.

While we see that the FHIR standard is being infused into the healthcare IT world, we also believe that these challenges can be overcome with a thoughtful, collaborative approach. As we continue to work with payers and providers in areas critical to the organization – revenue cycle, compliance, customer experience, intelligent automation and care management – we will continue to push for those technologies that hold the most promise for better care at a lower cost yielding a better experience for all.

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