FHIR 101: Solving healthcare’s interoperability problem

CMS is asking payers and providers to adopt FHIR standards to improve interoperability in healthcare. Get up to speed on FHIR with these FAQs.
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interoperability in healthcare

A new federal regulation requires that providers follow the HL7 FHIR standard for exchanging healthcare information electronically. Here’s a look at what this specification is all about, and why many believe its widespread adoption can transform patient care for the better.

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What is FHIR?

FHIR (pronounced “fire”) is the acronym for Fast Healthcare Interoperability Resources, an IT standard for health data exchange developed by Health Level Seven International (HL7). First proposed by HL7 in 2011, and then published as a draft in 2014, the FHIR Specification describes how data should be structured and organized to allow communication between healthcare applications. The latest version of the standard is FHIR Release 4, published in October 2019.

Why is FHIR better than other HL7 standards?

FHIR was developed as an alternative to other HL7 standards (like V2 and CDA) that many healthcare organizations have found difficult to use. Unlike its predecessors, FHIR relies on secure web technologies and application programming interfaces (APIs) that IT professionals already understand. The standard is adaptable “as needed,” HL7 explains, but it also provides organizations with a quick path to implementation through what it describes as “interoperability out-of-the-box.”

What are FHIR resources?

As the name implies, FHIR involves “resources,” which are categories of healthcare data. HL7 defines a resource — laboratory results, insurance claims, and patient data are just a few examples — as any “exchangeable content.” Each resource contains the data elements required for its specific use case, and it includes links to other resources that may also apply to that case. In practice, resources allow providers and other healthcare stakeholders (patients, insurance companies) to simply click on the information they need using a computer with a browser application.

What are some common FHIR use cases?

FHIR can be used in a wide range of scenarios, but two common applications include patient access to personal health records (PHRs) and the electronic exchange of healthcare data between payers and providers. In the case of a PHR, the healthcare organization’s electronic health record (EHR) system would include an API that allows patients to access their health information through the application of their choice. When it comes to electronic information exchange, on the other hand, an EHR API would allow a physician, for example, to access a patient’s prescription history by clicking on a link to their pharmacy’s IT system.

What makes FHIR a hot topic right now?

The big news around FHIR is centered around a new rule from the Centers for Medicare & Medicaid Services that’s intended to advance healthcare interoperability. As of July 2021, the agency has required payers and providers participating in its programs to implement a FHIR-based “Patient Access API” that gives patients access to their claims and clinical data. It’s also required that payers make provider information available to patients through a separate FHIR-based “Provider Directory API,” and it’s made it clear that organizations that fail to comply with the new mandates will face penalties and fines until they do.

As CMS explains it, “lack of seamless data exchange in healthcare has historically detracted from patient care, leading to poor health outcomes, and higher costs.” As organizations adopt the FHIR standard — voluntarily or otherwise — those days should eventually become a thing of the past.

To read more of IMO’s articles about the topic of interoperability in healthcare, click here.
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