Got FHIR? Understanding Interoperability Priorities for 2021

By: Charlie Provenzano

As we move deeper into Q1 2021, capability for compliance with the CMS Interoperability and Patient Access final rule (CMS-9115-F) and ONC Cures Act has moved from simply important to both important and urgent for healthcare payers. According to the mandate, most payers must enable member record exchange by July 1, 2021 or risk possible enforcement actions. Interoperability is at the core of this mandate, specifically Patient API and Provider Directory data exchange using the FHIR (Fast Healthcare Interoperability Resources) standard. The bottom line? It’s time for payers to get onboard with FHIRprotocols and tools.

What is FHIR?

In the acronym-rich world of healthcare, FHIR (Fast Healthcare Interoperability Resources) is one you really need to understand. FHIR unites the standardization of the HL7 message format with the real-time request-based structure of a web-based API. It simplifies getting timely access to data from disparate systems, applications, and devices. And though FHIR resources are standardized, the returned data is customizable based on the request, making FHIR highly versatile. FHIR is stable, secure, and free to use for seamless data-sharing with health plan members, providers and payers. (Read the backstory on FHIR development for healthcare interoperability.) And although, for the last 14 months the overwhelming emphasis has been placed on the mandates that are part of the CMS Interoperability and Patient Access final rule, the FHIR standard has applications far beyond this one rule.

Leveraging FHIR in your Organization

One of the benefits of FHIR is that payers need not start from scratch when it comes to applying it in their organization. Since 2017, the Da Vinci Project has been developing workflows for specific health data exchange use cases. Da Vinci is a private-sector group of health information technology technical experts and industry leaders collaborating to advance adoption of HL7 FHIR as the standard for value-based care (VBC) data exchange in the U.S. As each use case is adopted, Da Vinci makes available an implementation guide and accompanying reference implementation projects to help payers determine if and how the use case could be applied in their organization. The guides contain FHIR-specific terminology, notations, and design principles, and they make a valuable starting point as you define your compliance plan and specifics of your implementation. Find more details about Da Vinci use cases.

Another advantage of FHIR is that in addition to using it for data sharing with other healthcare entities, payers can also use it to connect data from disparate systems within their organization. Many large payers have internal FHIR servers that make reliable data available to their external FHIR servers. That is the versatility of FHIR: Payers can have multiple FHIR servers with different purposes, sources, and destinations, but the FHIR resources are the same.

At some point in your organization’s journey to compliance with the CMS Interoperability and Patient Access final rule and the ONC Cures Act, you’ll need to decide if you will build your capability with existing resources or partner with an interoperability vendor. The tools needed for compliance are publicly available at no cost, and some payers already have an established team for interoperability programming that can take ownership of this effort.

However, if your time and/or resources are already allocated, you have a large and complex IT environment, or you have both internal and external interoperability challenges, then a partnership may be the most cost-effective and assured route to go. The HealthLX FHIR Enterprise solution enables organizations to cross the finish line on the mandated FHIR standard compliance without building from-the-ground-up solutions or replacing legacy systems. We also provide consulting services by healthcare technology professionals with extensive FHIR experience if you need guidance in navigating the compliance requirements. The HealthLX FHIR Starter Pak is a free download that helps payers get a jump-start on their path to CMS Interoperability and Patient Access final rule and ONC Cures Act compliance.

FHIR Supports Value-Based Care

The interoperability which FHIR enables makes it essential for the transition to value-based care. With improved access to their healthcare information, patients can take a more direct role in managing their own healthcare. Providers can deliver more patient-centric care, and payers can create a better member experience. As payers are already finding, the conversion of data to FHIR resources takes effort, but the benefits of value-based care models and payers’ expanded ability to use FHIR resources in other ways can create considerable ROI.

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