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FHIR Interoperability: What is it and Why Should We Care?


Fast Healthcare Interoperability Resources, or FHIR, is a long-awaited interoperability rule that will enable seamless, on-demand information exchange of clinical records among providers and data systems and will result in coordinated, cost-efficient care.

Early in March 2020, the Office of National Coordinator of Health IT (ONC) and Centers for Medicare and Medicaid Services (CMS) finalized the long-awaited interoperability rule. Since this announcement, the world has been grappling with an unprecedented pandemic and the importance of interoperability has only become more urgent. 

With the COVID-19 outbreak, healthcare data interoperability has become an increasingly pressing concern for healthcare organizations. Healthcare experts have long proposed that easy sharing of clinical records among providers and data systems would result in coordinated, cost-efficient care. Patient rights advocates have also encouraged secure data sharing to improve patients’ and their providers’ access to critical patient information. As a result, there’s a great deal of attention towards the data standards that will enable seamless, on-demand information exchange, such as FHIR, or Fast Healthcare Interoperability Resource.  

FHIR is one of the most popular protocols for connecting disparate data systems and sharing data in a secure manner. Since the interoperability rule released by the Office of National Coordinator of Health IT (ONC) and Centers for Medicare and Medicaid Services (CMS) states the adoption of FHIR Release 4 for API-based data exchange, it’s important to get answers to certain important questions. 

What is FHIR 4 and how can it help health IT interoperability?

FHIR surfaced in healthcare almost five years ago as a Draft Standard for Technical Use (DTSU) that leveraged existing, well-established, web-based standard concepts altered to fit clinical data exchange. The modern interoperability standard is an essential component of health information exchange in modern health IT and in early 2019, had the 4th release, or R4. 

FHIR 4 builds upon the legacy of DTSU2 and v3, and like previous versions, this version lets data travel in discrete pieces. Along with RESTful application programming interfaces (API), the version also includes additional stability for several of the standard’s elements, which will result in fewer challenges in leveraging it. 

FHIR 4 is a balloted and passed standard that would be a normative standard, which means the specification is considered ready for use and stable, and further FHIR versions will be required to be backward compatible with the R4 components. This would make building apps off this version easier to be supported for the foreseeable future. 

How does the ONC final rule promote FHIR standards?

According to the ONC final rule on interoperability, Medicare Advantage, Medicaid, CHIP and other health plans on federal exchanges will be required to support a standardized API, supported by FHIR 4. Starting January 1, 2021, the rule requires that APIs being developed to allow patients to access claims and other critical information should meet the FHIR 4 standards. The rules will also create an implementation guideline for FHIR, which would reduce variability in how to implement the standard, and would simplify the interaction of different technologies to exchange and interpret data. 

Under the current regulations, ONC also calls for the implementation of a Provider Directory API among the CMS-regulated payers. This API would provide third-party app developers with means to connect patients with a bigger number of providers or to help providers connect with each other for better care coordination. Having a standard mechanism such as FHIR 4 is critical to enable access to patient information, regardless of where it originated. 

How can FHIR API-based data exchange support a patient-centered approach to care?

Many healthcare experts agree that APIs are more secure than current batch-oriented methods and can be the key to enabling meaningful data exchanges between systems. The final rule by ONC requires two types of API enabled services: one focusing on serving a single patient’s data, and one servicing multiple patients’ data.

Depending on how they are configured, APIs can be instrumental in enhancing data exchange, especially as the final interoperability rule requires the support of standardized APIs that allow patients to access their information. Healthcare APIs acting as bridges to allow seamless communication among healthcare providers, payers and patients can help improve efficiency and productivity, which will have a direct impact on patient care. 

Apart from empowering patients by giving them increased access to their healthcare information, APIs can also reduce physician burden and improve patient care. For example, APIs can deliver crucial data from electronic health records (EHRs) to physicians such as recent patient health history, thus reducing unnecessary burden on them. Additionally, APIs can be helpful in creating more meaningful patient experiences. Delivering interoperability will empower patients to manage their healthcare the same way they manage their finances, travel experience and other services. 

The road ahead: advancing interoperability for the future


Demand for interoperability among healthcare systems has grown dramatically in recent years, and more so with the COVID-19 outbreak. With changes in healthcare payment models such as value-based reimbursement, there is a growing need for real-time data exchange among healthcare providers to promote a coordinated care experience, much like other convenient experiences in life. FHIR 4 is a big step forward to the improvement of interoperability and patient access to data, opening up countless new opportunities to improve the patient experience of care and the drive to quality through greater coordination. 

Mike Sutten is chief technology officer of Innovaccer and has more than 25 years of leadership experience as a CTO and Chief Information Officer with Fortune 500 organizations, including Kaiser Permanente, Royal Caribbean Cruises, Koch Industries, Sybase and General Electric. Most recently, he served as CTO and senior vice president at Kaiser Permanente where he led initiatives on analytics, cloud capabilities, data storage, and mobile technologies.

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