The moment is now. The answer is FHIR.

As I eagerly await the Final Rule to be released around Interoperability and Prior Authorization, I can’t help but to reflect back on how we got here. A decade ago, FHIR was just another nascent data standard trying to solve the same problems as the many other data standards that came before it. They had all failed to deliver the full value promised. Why would FHIR be any different? Now, arguably, a select handful of those other legacy standards have done and still do a great deal of heavy lifting, operationally, for organizations, a testament to their non-trivial, actualized value.

A Look Back on the FHIR Standard

But, in any case, ten years ago, to many, FHIR was just another health IT flavor of the month buzzword that ended up in the regulatory flavor of the month: Meaningful Use. And that combination started something.

Ten years ago, meaningful use was underway in earnest. Today, a decade later, we have FHIR capabilities available from most providers across the country through widely adopted electronic health record (EHR) systems, like Epic and athenahealth.

FHIR proved to be a scrappy little standard. In early March of 2020, CMS announced that payers with government-backed plans, like Medicare Advantage and Medicaid, needed to stand up FHIR tooling. By late March of 2020, the world changed starkly. More than three years later, as we wake up from the fog, those FHIR capabilities are live at payer organizations across the country and now this winter we’re expecting new rules that will enhance and expand the FHIR capabilities required of payers.

Take Advantage of FHIR Now

So here’s the thing: the new rules (in theory) are actually super cool. We’re done with the rote work of simply making existing data available in FHIR. Now we’re going to put that data to use and exchange it between organizations, ostensibly, to improve outcomes.

Take a moment to appreciate and savor the moment. Look how far we’ve come. The tomorrow we’ve been preparing for has arrived. I believe passionately that this new infrastructure is being seeded in the industry not simply as a checkbox for the few use cases being discussed in regulations today. Rather, this is the foundation for a new, revolutionary way of delivering care.

Many forward-thinking organizations realize that the sooner they lean into FHIR, the sooner they can start to do things in better ways. And making the system run better in small but meaningful ways doesn’t have to be onerous. It’s simply a matter of working smarter, not harder, so you can re-focus on solving the more important problems instead of simply the ones in front of you.

What manual or custom data exchange processes can you optimize? Digital transformations can drive significant improvements in operational efficiencies, while substantially decreasing administrative overhead. Perhaps:

    • Acquiring USCDI data directly from EHR FHIR APIs – replacing custom extracts, CCDAs, and manual processes for collecting clinical data
    • Sharing claims data via FHIR APIs – replacing custom, monthly flat file, and SFTP work for timely exchange of financial information

But whether through government regulations or forward-thinking zeal, data exchange cannot happen without two willing parties to, well you know, actually perform the exchange. And unfortunately many organizations are still resistant to re-imagined data sharing strategies on top of modern technology, preferring to stick to the status quo. 

That hesitation has come with a price. According to the Council for Affordable Quality Healthcare (CAQH), manual methods, such as paper, mail, and fax, cost the healthcare system $25 billion a year. That number is expected to increase as medical record requests from payers to providers  grow 20-30% per year. Not only do these antiquated collaboration methods create unwarranted hassle and substantial costs, but they also slow down the pace of care, leading to less-than-great patient outcomes and satisfaction. There has to be a better way. A world with:

    • Faster data exchange for critical populations
    • Less burden and expense from chart chasing
    • Better satisfaction from patients
    • Less abrasion between disparate organizations
    • Increased data value and utility
    • Less inefficiency managing disparate report formats and data models
    • One consistent source of truth for patients, providers, and payers

The time is now for the industry to reinvent itself. As I wait for news from DC, it’s clear that the government has a view of the future we’re moving towards. The question is, how long will it take for the private sector to get onboard. There is no better day than today to double down on your commitment to being the change we all deserve. Make FHIR work better for you. Make FHIR work better for us. If not now, then when?

Share with your community

Sign up to get the latest insights and updates from 1upHealth