FHIR burns bright as a key component of fed’s interoperability initiative
The industry’s information exchange standard will play a big role in enabling seamless data sharing across the industry.
It looks like prime time has finally arrived for the Fast Healthcare Interoperability Resources standard.
The FHIR standard, long developed and promulgated by Health Level Seven, appears to be a key cog in the CMS Interoperability Framework. The framework is intended to enable the easy and seamless sharing of information between patients and providers, which also portends the improved exchange of information between players in the healthcare industry.
FHIR has been a standard in development for about a dozen years with the aim of replacing complex, older standards with simpler, API-based technologies like REST, XML and JSON, using modular resources for data exchange. These Internet-based protocols have long been seen as a way to accelerate and ease data sharing with the goal of improving patient care, data analysis and the development of new healthcare applications.
That fits hand-in-glove with the stated aims of the federal government, spelled out in its late-July announcement of an initiative to create a next-generation digital health ecosystem.
FHIR’s role
For example, CMS noted it has begun building a FHIR-based API to enable apps “to find provider networks, participants and relevant endpoints, while also improving data quality and mapping complex provider hierarchies.” The agency will be launching initial functionality of the new provider directory and expand iteratively starting later this year.
Additionally, CMS says it intends to develop infrastructure to reduce claims hassles through Blue Button initiatives, intended to facilitate data access. Part of this would entail the development of FHIR-based digital insurance cards, which CMS said could be available “as soon as this year to app developers and Medicare.gov users.”
Beyond that, CMS has set a variety of goals involving FHIR, such as asking providers and EHR developers to make electronic medical information accessible to “CMS Aligned Networks,” with structured data flowing through FHIR.
CMS also is seeking to encourage the “Kill the Clipboard” movement, for example by eliminating manual check-in forms and fragmented data collection “by enabling patients to share their verified health and identity information directly with providers at the point of care – and receive their visit record back – using modern digital tools built on FHIR.”
The standard is ready
The federal agency’s inclusion of FHIR in its data exchange plans is an important of acknowledgement HL7’s efforts to develop the standard to meet various needs, says Viet Nguyen, MD, the founder of Stratametrics and the technical director for HL7’s Da Vinci Project, a payer-provider-vendor collaboration addressing value-based-care use cases and developing HL7 FHIR-based standardized solutions.
“This administration puts less emphasis on regulation and more emphasis on the industry leading efforts, which works pretty well with the work we do in Da Vinci,” Nguyen says. Other accelerator projects within HL7, such as the CARIN Alliance (for consumer-directed payer data exchange) play prominently in CMS’ plans, he noted. Other HL7 initiatives that could plug into future federal interoperability pushes include the Gravity Project for social determinants of health, CodeX for patient care and research, and Helios for public health information.
HL7 has long worked with federal agencies to familiarize them with FHIR’s capabilities and educate them about its potential role, Nguyen notes. For example, the organization recently hosted about 50 staff members of the Centers for Disease Control and Protection for education on the role FHIR could play in public health. And over the years, HL7 has briefed about 500 people within CMS on FHIR’s potential, which has kept agency staff up to speed on FHIR, its capabilities and prospects for achieving use cases.
More work ahead
While the FHIR standard is considered to be fairly mature, Nguyen acknowledges that more work is needed to help bring the industry up to speed and to assuage concerns that FHIR and adjacent technologies are not ready to handle massive transaction volume.
For example, while Da Vinci-based applications of FHIR have gone through extensive vetting processes, some of the value-based care use cases have not been widely implemented across the industry.
“There are a few sleepers in terms of adoption,” he acknowledges. “Clinical data exchange is good in that we’re not having to hand-hold a lot of organizations anymore. We’re still concerned that smaller organizations have not prioritized implementation (of FHIR and FHIR-based applications).”
Development of APIs can take time and wide cooperation as well, Nguyen noted. And achieving interoperability requires institutional buy-in. “It’s a vertical throughout an organization, from the top dogs down. Everyone in the organization needs to have some familiarity with (FHIR).”
And the capacity of the widespread use of FHIR to exchange large quantities of data – commonly called bulk FHIR – is a concern for some healthcare organizations. HL7 is working on building confidence in the standard’s capacity. While FHIR capabilities are sufficient for now, experience with large data volumes will grow over time, Nguyen says. “We’ll learn, over the next couple of years, how best to optimize bulk exchange,” he says.
The need for collaboration
HL7 continues to work with other industry organizations, such as ANSI X12 and NCQA, on multiple facets of information exchange, and that will be key to achieving federal and industry initiatives.
And finally, industry-wide collaboration will be key to expanding the use of FHIR. “Within the Da Vinci Project, we were able to demonstrate that payers and providers are able to work together, and that also helped to close that trust gap,” he says. “We’ve demonstrated that a collegial atmosphere of trying to do the best for the patients is the goal. We hope that attitude will spread, as it needs to if we’re going to really provide value-based care.”
Fred Bazzoli is Editor in Chief of Health Data Management.