The new Fire that burns the Healthcare
An introduction to FHIR®.
Nowadays everyone wants their healthcare information whenever they need it, all in one place. Let’s pay a visit to the FHIR® who is trying to improve the quality of the data exchange in Healthcare and see how it works.
The term ‘Interoperability’ comes with the idea of sustaining an effective exchange of data among different networks, systems aiming to achieve the benefits of a much-improved data exchange. Regardless of the field the network belongs to, it would always add more convenience over a standalone network where data exchange between them is quite complicated and expensive. Healthcare industry is at a place where information technology is evolving to play a critical role in managing services and the healthcare network which may consist of healthcare service providers, patients, payers & the healthcare IT developer community itself. Healthcare IT operates at a level where all of the above-mentioned groups bear many-to-many relationships with other parties thus making the attempts for a greater interoperability more complex.
What is FHIR?
Fast Healthcare Interoperability Resources was introduced by HL7® as a standard for exchanging healthcare data electronically. FHIR was initially released in 2014 as a Draft Standard for Trial Use (DSTU). With a much more engaging community around HL7 FHIR® than it was with the HL7v2 (a HL7® standard that came prior to the FHIR®) & the recent emergence of the USA based rules regarding the healthcare data interoperability, everyone seems to be on FHIR® to be compliant with the latest standards & regulations of healthcare.
FHIR® provides standardization over data formats, elements (described as ‘resources’) & the application programming interfaces (APIs) which allows the developers to build web applications where the data is accessible regardless of the EHR systems or network securely. FHIR® resources can be used to create documents (in XML/JSON formats) that may consist of the complete set of related clinical or non-clinical information. FHIR® could be a long-term solution for the whole healthcare industry where the issues arrived with the hindrances of data interoperability will be answered.
Why FHIR is better than previous HL7® standards?
Before FHIR was introduced, HL7v2 & HL7v3 have been in the play for quite some time, but haven’t got to penetrate the Health IT at a speed as much as FHIR. Even though HL7v3 was introduced as a successor to v2, it wasn’t compatible with the v2 which made it difficult for the developers to continue with the transition to v3. Both these protocols were more complex and needed a deeper level of expertise for implementation. FHIR® was introduced as a solution for the limitations that the previous versions had presented by that time.
Interoperability & Patient Access Final rule by CMS
The interoperability and patient access final rule (CMS-9115-F) is a recently introduced regulation by CMS & provides several policies where the patients will enjoy the accessibility of their health data whenever they need it. The other stakeholders including providers & payers should be compliant with the rule in order to manage a better patient care and a healthcare system. Medicare Advantage (MA) organizations, Medicaid Fee-for-Service (FFS) programs, Medicaid managed care plans, CHIP FFS programs, CHIP managed care entities, and QHP issuers on the FFEs are being regulated by the rule which consists of 3 main policies as Patient access API, Provider directory API & a Payer-to-Payer data exchange with the current deadlines for implementing being July 1st 2021 for the first two policies and January 1st 2022 for the later one.
Patient Access API: Patients must have the ability to access their health data at any time they need without the assistance of any other parties. As the rule says ‘CMS regulated payers and above-mentioned parties are required to implement and manage a standard based API (FHIR® R4) that allows patients to access their claims and encounter information including costs’.
Provider Directory API: Above mentioned parties are required to make the provider directory publicly available via a standard based API.
Payer-to-Payer data exchange: In summary, CMS-regulated payers are required to facilitate the exchange of data of a patient upon a request to carry the information with them when a patient is moving from current payer to another payer. This will create a cumulative & complete health record of a patient with their current payer.
FHIR® 4.0.1 (R4) API has been named as the data standard for all 3 policies.
Aligning with the CMS Patient Access Final Rule, The Cures Act final rule from the ONC is again pushing forward the interoperability in the healthcare sector. The rule revolves around the patients, providers and the developers of health IT focusing on secure access of health data for patients and provides definitions of Information Blocking & exceptions on it & imposes several conditions on APIs.
Both of these rules escalate the adaptations of the FHIR® standard within healthcare IT.
FHIR for the future
Without doubt FHIR® has the capability to be the driving force of a seamless & secure data exchange for the healthcare industry more than any protocols that came before. FHIR® may power the much-needed functionalities over data handling including more sophisticated filtering capabilities than always exchanging bulk data, data analytics which is critical for knowledge sharing. Patients might no longer have to worry about a scattered data pool with several providers & payers since FHIR® helps to minimize the effort to maintain a continuous health data record of a patient including a complete view of medications & related information.
FHIR® and the rules & regulations built around it also helps to create a secure data exchange where privacy of the patient’s health records are valued. And the vast variety of IOT devices including Apple watches, Fitbits, other fitness trackers and thousands of mobile applications could be benefited by FHIR®.
A better Care coordination is another much desired outcome of FHIR® where providers would be able to serve the best care they could offer, for patients coordinating with other providers. By now most of the key players in Healthcare IT (vendors, payers, providers, EHRs) have focused their services, systems & products for FHIR® adaptations. Developers are exploring new and innovative ways to develop applications on top of FHIR® which possibly create a rich pool of applications that would offer powerful features for the healthcare network addressing the current problems with interoperability.
Adapting & moving forward with FHIR® would be a joint effort of everyone that interacts with healthcare. This will ultimately result in better health services for patients and improved & transparent IT infrastructure for a united future development in the healthcare sector.
