Telling the Tale of FHIR to the Uninitiated

In the present moment, the advocates and evangelists of FHIR are attempting –and struggling –to tell the story of how the creation and use of standard data formats and elements for exchanging electronic health information is on the cusp of potentially revolutionizing healthcare.

An example of what is going into that storytelling can be seen in the informative presentation sponsored by Health Level Seven Internation (HL7) and Citius Tech, “Payers on FHIR®: Opportunities to Advance Value-Based Care,” earlier this month.

Led by HL7’s Chief Technology Officer, Wayne Kubick, Aneesh Chopra President, CareJourney and Former Chief Technology Officer of the United States and Swanand Prabhutendolkar, Sr. Vice President for Data Management at CitiusTech, the presentation is a study in what is required to tell the story of FHIR’s value outside of those already initiated into the culture and language of healthcare data interoperability.

While the ostensible purpose of the presentation was to facilitate “understanding different opportunities to accelerate the shift to value-based care,” and “how [healthcare] payers can advance the shift to value-based care models with the development and deployment of interoperable solutions,” how that gets done in this presentation is instructive of where we are in the present moment.

The presenters begin with an overview of how FHIR, and the associated vision of interoperability it represents, is not being driven by the marketplace, but by potential federally mandated rules and regulation. Specifically, the presenters review how the Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health Information Technology (ONC) have developed a proposed rule that will drive FHIR adoption.

They then do what all FHIR-informed presentations must do when speaking to a general audience: they give a primer on the history and definition of FHIR. Such education is necessary for advocates because FHIR is not simply a technology fix, it is a human/language/data/technology fix for the Tower of Babel that is the current Healthcare world.

The presenters end with observations about “Impacts” and “Opportunities,” in some largely aspirational, future state.

For the initiated the takeaways from webinar presentation are substantive:

• Two important players (Payers & Providers) in Healthcare industry are getting signals of big changes from CMS/ONC
• A big shift is on horizon to release/modernize X12 EDI data (claims, payment, eligibility checks, etc..) into FHIR
• Unleashing decades worth of EDI X12 837 – claim data through FHIR transformation will empower clinical research and distribute historical data for data science, clinical research, etc.
• CMS is getting more vested in exposing data interoperability through FHIR & unlocking medical data for patient access through maturing FHIR R4 standards
• Consumer Directed Exchange will become primary driver of HIE (Health information exchange)
• Government-sponsored Plans under new obligations to share data
• Hospitals under-coming under new obligations to share discharge notifications
• Quality Measure data could be delivered by FHIR standards to enable eCQMs (Electronic clinical quality measures)
• Access to different slices of medical data would be standardized through FHIR to supplement socio-economic determinants of health
• Number of HL7 FHIR Accelerator programs includes communities and implementers to address common use cases using FHIR standard. Example: CARIN Alliance, Gravity project, etc.
• Da Vinci Project is marrying clinical data with claims data… A big win for both parties through FHIR interoperability. But more importantly, cutting wait time in claim & health related data decisions that exchange will empower
• Dominance of BIG Healthcare Corporations will diminish … as API’s will be exposed to authorized entities via HL7 FHIR standard… Era of “substitutable” apps and vendors will become reality…. Cost savings for taxpayers could be significant
• Something big going on with CMS Data at the Point of Care API, a pilot program which is using FHIR BULK Data access standards to exchange patient data across provider systems…
• Standardizing Social Determinants Of Health Assessments does not sound like sci-fi with what FHIR brings on the table
• Even more importantly close to real time clinical data exchange will save millions of lives in emergency rooms

As important as the FHIR standard itself will be, even more necessary is the creation of a shared story of value, purpose and moral urgency for the healthcare system that FHIR could facilitate. We don’t have that story yet, but technologists and care visionaries are working on it.