FHIR® may be the future of healthcare data, but payers want more

This article was originally published by Healthcare Finance, a publication of HIMSS Media on March 17th, 2022. Click here to view the original posting.

ORLANDO, Fla. – Healthcare has undergone a number of policy and technology shifts in recent years, and at the intersection of these changes is Fast Healthcare Interoperability Resources, or FHIR®. It’s a standard that describes data formats and an API for exchanging electronic health records, and while many in the data business consider it the future of healthcare, payers say they need something more.

Don Rucker, chief strategy officer for 1upHealth and the former National Coordinator for Health IT, called FHIR “transformational.”

Speaking at the session “FHIR is the Future of Healthcare, But Payers Need More” at HIMSS22 in Orlando, Rucker said that while healthcare has traditionally had its own standards when it comes to data and data exchange, FHIR was built on the standards of the internet, and so for the first time, those in the industry get to use the tools of the broader economy, “which, if you’re a computer nerd, is very exciting,” he said.

The trick, said Rucker, is to make FHIR work in a consumer-centric environment. In order to effectively provide data to patients and providers, it’s important to think about how to make the data exchange in real time.

“In our consumer lives, we’re not going to wait,” he said. “And if you don’t follow those principles, you can think of yourself as a taxicab operator in the world of Uber or Lyft.”

To handle new business cases, it’s helpful to think about how FHIR resources are represented, and before it gets out to APIs or analytics, the big thing to consider is privacy. Privacy, said Rucker, is the issue of our lives on modern computing.

Joining him on the stage was Diane Gabrielsen, vice president of IS delivery at Network Health WI in Wisconsin, who noted that while there were minimal data sets that had to be provided, her organization didn’t want to just check a box for compliance. She considered FHIR to be the future.

“We’re all on the same standard,” said Gabrielsen. “I can talk to all the providers in the same language. I can share the data because we have it, and I can share other information with those providers that’s relevant to them.”

A top consideration for her and her team was the privacy and location of the large volume of data in question. The big question for her was whether Network Health MI was structured for FHIR. As a smaller provider handling all this data, she knew that any approach had to be scalable and secure, and the organization had to make the investment in enhancing its data warehouse – essentially rebuilding it, which necessitated finding partners to help them do it. 

“Member API is step one – a baby step,” said Gabrielsen. “Everything else that happens, happens around that member. And we’re going to get there with payer-provider exchanges. We’re enhancing processes.

“It’s all about the analytics,” she said. “It’s about the data itself, so we can start to use the analytics to really promote patient wellbeing, really promote a forward-thinking approach to how we’re going to do care management. Providing those analytics was another huge key for us.”

To make that valuable for the patient long-term, payer-to-payer communication and interacting with the provider are essential, as well as facilitating care transitions through all stages of a person’s life in concert with that provider.

“We have to step back from our own selfishness and invest in that, so the cost of care can come down over time,” said Gabrielsen.

According to Rucker, Washington, D.C., and the country at large are in an existential crisis when it comes to paying for value. The problem thus far with the push to value-based care has been the lack of tools to do it effectively.

“We came up with what was, at the time, a state-of-the-art pastiche of quality measurement as a proxy for consumer value, which I think is a pretty slim proxy,” said Rucker. “We’ve had these things that are half-solutions, because we don’t actually have the data. We don’t actually know everything because we don’t have it, so we’ll say, ‘Let’s measure these things.’ They’re really narrow. They’re not what I as a patient would want. Now with big data we have the opportunity that retail has had – big data, volume, variety, velocity. That is what makes FHIR powerful. We finally have a way to answer the value question in a totally different way.”

One of the problems, said Gabrielsen, is that there are holes in interoperability. 

“It doesn’t go far enough,” she said. “We need that payer-to-payer to happen. Providers are interested in growth, in growing the patient base. Your patient base comes from us. … When payer-to-payer happens, I’m going to have more info about that patient than you will the day they walk through the door. Yet there’s no commitment on the table to get from you to me, to get it. It’s an ongoing healthcare inefficiency.”

Rucker said FHIR is innately doable. There wouldn’t be two million apps in the app store if it was impossible, he said. People need to be clever about what models will allow them to have a different interaction with the patient, and a better level of service that yields better results. That, he said, is the opportunity.

There’s an advantage for those who move first, he said.

“In healthcare we’ve had a very insular existence,” he said. “The world is changing. You need a lot of computing power to do this, you need partners, but that’s what will really transform the healthcare environment.”

About HIMSS Media:

HIMSS Media is an innovative full-service digital information and in-person events group that supports HIMSS’ mission by delivering trusted information and insight to members and a global audience of healthcare technology decision-makers and influencers.

About 1upHealth: 

1upHealth is the leading FHIR® platform that connects an ecosystem of payers, providers, patients, life sciences, and app developers within a trusted interoperability network. Unlike legacy enterprise companies, 1upHealth was created and built with the modern healthcare infrastructure in mind. The 1up FHIR® platform is serverless with cloud-native applications that transform data at enterprise scale with greater ease and simplicity to improve patient outcomes, drive population-level analytics and enable medical innovation. Founded in 2017, the company is connected to more than 10,000 clinical and payer endpoints with best-in-class FHIR® APIs. Gartner designated 1upHealth a “Cool Vendor in Healthcare Interoperability” for its FHIR® platform.