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TEN TRANSFORMATIVE TRENDS 2020 Interoperability Regulations


Reinforce FHIR’s Central Role The use-case approach is serving FHIR accelerators well By David Raths


T TEN


he Fast Health Interoperability Resource (FHIR) standard has been a bright spot in health IT for the past several years as informatics leaders coordinated by HL7 have made consider- able progress on fi nding ways to share data in more granular and plug-and-play fashions. Now it is time to scale up those efforts.


When the fi nal interoperability rules issued in March by the Offi ce of the National Coordinator for Health IT (ONC) and the Centers for Medicare & Medicaid Services (CMS) called for using FHIR and standard application program- ming interfaces (APIs), it was seen as a game changer. “We have been waiting for this, but it kind of formalizes the importance and criticality of FHIR in the world of health- care information,” says Wayne Kubick, chief technology offi cer for the nonprofi t HL7 standards organization. “It is one thing to say it is going to happen some- day. It is quite a different thing that it actually did happen. We are in a world dealing with a health crisis and it just


technologies from a few years ago.” The ONC fi nal rule calls for use of FHIR Release 4, which is the release with the fi rst normative content. Developers can build around it and not worry about backward compatibility with the core technological components, Kubick says. Release 5 is expected sometime in 2021. One of the visions clinical informatics executives have had is that a thriving FHIR-based app market would develop atop EHR platforms, so that innovations could be spun up more rapidly. While those EHR app stores have developed, there is still more work to do to totally unleash them. “When we did applica- tion roundtables, we were surprised to see how many small startups were using FHIR to build things the world just wasn’t aware of,” Kubick recalls. “Their time is coming now. We will see a whole lot more popping up.”


One of the things that has allowed rapid progress has been the creation of a series of HL7 “FHIR Accelerators” to focus on use cases that are of critical importance to stakeholders, including the initial accelerator focused on clinical settings, the Argonaut Project.


A Da Vinci masterpiece Wayne Kubick


reinforces the importance of information being readily available, exchangeable and usable, no matter where it comes from, to be used at the macro level, from the public health level, and from the individual level in terms of treating patients.” Providers have to be fl exible, he adds, and FHIR makes it possible to build solutions rap- idly. “That just wasn’t the case with the


One of the FHIR accelerators that has made considerable progress over the past year is the Da Vinci Project, which was launched in 2018 as a multi-stake- holder effort led by payers, providers and health IT vendors to address use cases in value-based care. The group wanted to cut down on custom one-off work between payers and providers and reduce the need for unique solutions. Jocelyn Keegan, payer practice lead for consulting fi rm Point of Care Partners and program manager of the Da Vinci Project, says that after defi ning numer- ous use cases and working through the HL7 balloting processes, now is the time for the project members to start using the interoperability guides. “We are at an infl ection point where the roles and responsibilities pivot from the project team back to the membership as the implementation guides are being used


TRANSFORMATIVE TRENDS


2020


in a pre-production and production environment.” The group is working on projects


around data exchange for quality mea- sures and coverage requirements dis- covery. Some members are going live with coverage requirement discovery pilots that would allow a physician to see any prior authorizations or require- ments before scheduling a patient for surgery, for instance. “This can help steer that patient’s journey and improve out- comes,” Keegan says, “by bringing ben- efi t information right alongside the care and treatment plan.” The key to progress is to identify solu- tions that have real return on investment for both providers and payers, she says. “Our approach is by looking at things on a use-case basis, and now grouping those into families and areas, we can create a community of people who work on these problems every day. We give them a place to share those solutions and add exam- ples. It is very rare in a career to be in a place where an industry is fundamentally changing how it works, and at Da Vinci, we are getting to experience that.”


Feeling gravity’s pull A more recent FHIR accelerator, the Grav- ity Project, grew out of efforts to identify data elements for sharing information about social determinants of health. Building on work done by researchers at the Social Interventions Research & Evaluation Network (SIREN) at the Uni- versity of California San Francisco, the project was not initially FHIR-focused. “We were focused on identify data defi - nitions for documenting social determi- nants of health in clinical systems, which involves defi ning what we mean by


continued on page 5 MAY/JUNE 2020 | hcinnovationgroup.com 3


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