This world is on FHIR

The Centers for Medicare and Medicaid Services’ (CMS) Interoperability and Patient Access final rule, along with the 21st Century Cures Act’s interoperability and information-blocking rule, call for streamlining data exchange between healthcare providers, patients, and payers, while protecting stakeholders against “information blocking.”

The legislation, which goes into effect April 5, 2021, also calls for transitioning existing EHR specifications to the HL7 Fast Healthcare Interoperability Resources (FHIR) standard.

However, many healthcare stakeholders, as well as health IT vendors, aren’t prepared for FHIR implementation and still may not be by winter’s end. Out of the thousands of EHR vendors in the country, only about 680 have been certified as compliant with the most updated clinical data set. Furthermore, nearly 80% of providers, payers, hospitals, and vendors who participated in a recent survey from the eHealth Initiative reported that the COVID-19 pandemic was hindering their ability to prepare for the forthcoming regulations.

And while many of these vendors are playing catch up, the industry standard will continue to evolve. By 2022, CMS has indicated that the current, de-facto HL7 standard, and its respective APIs, will likely sunset.

To keep from getting left behind, healthcare organizations need to ensure they have a plan in place for a smooth transition.

The Emergence of a New EHR Standard

While CMS and ONC have extended compliance deadlines from January to April, transitioning to FHIR (pronounced “fire”) won’t be as easy as flipping a light switch.

Since its release in 2014 as a “trial” standard by the Health Level Seven (HL7) International Organization, FHIR has been hailed as the driver of true interoperability. As the ONC noted on P. 115 of its final rule, “the HL7® FHIR® standard represents health information in what are called ‘FHIR resources’ [and] when it comes to logically organizing FHIR resources that relate to one another and share common properties, FHIR uses a concept called a ‘compartment,’” which links clinical, financial and other resources tied to that patient. The end result is an organizing framework [that] provides a potentially rich set of a Data Classes and Data Elements to consider for inclusion in the USCDI, including clinical, encounter, specialty, and financial data.”

Yet while FHIR’s success in enabling interoperability is hailed, healthcare leaders have expressed concerns over whether their EHRs will be able to support a more advanced organizing framework–especially if they’re part of an independent and/or small practice and lack the resources of a larger healthcare system.

There are also questions—and concerns—over whether care partners will adopt the same version of FHIR to facilitate data exchange, and how true interoperability will work if these partners aren’t keeping up.

Organizations that lack in-house health IT expertise may find the depth of the interoperability and information-blocking regulations overwhelming, and not know where or how to leverage their financial resources to ensure compliance.

Warming up to FHIR

Healthcare providers don’t have to navigate the complex transition to FHIR alone, but they’ll still need three things: an EHR that’s compliant with the 2015 Edition Health IT Certification Criteria; a technology vendor partner that has their back; and a communications strategy for patients and partners about interoperability and information sharing.

The need for an EHR that meets the 2015 Edition Health IT Certification Criteria and associated Common Clinical Data Set is top priority, as FHIR can’t run without it. Healthcare organizations need to check with their vendors to ensure the organization’s EHR is certified and that there won’t be problems down the line in meeting regulatory requirements. If an organization is sunsetting a legacy EHR and shopping for a new system, these questions are still important.

But having a certified EHR is only the first step. Physician groups need a technology vendor partner that actively keeps up with regulations, and has a roadmap for rolling out, and upgrading, FHIR over the next few years as the standard evolves.

While patients and payers won’t need a lesson on FHIR, a broader communication strategy around interoperability and information sharing is essential.

Patients will be sharing a lot more data and may have concerns about how the data will be used. A gun owner might worry that their primary-care physician will find out they are seeing a psychiatrist. An individual who has an STD may fear that lab results will be shared with third-party vendors. Healthcare providers will need to be able to assure patients that HIPAA and other privacy protections remain intact, and that patients ultimately control who sees their health data.

The new interoperability legislation, and the adoption of FHIR, are a step in the right direction, as care coordination gains greater importance amid the pandemic. While some providers may not understand what differentiates FHIR from fire, having a solid roadmap for technology migration is the best way to ensure compliance in 2021.

_{About the Author}

_{Roland Therriault is president and executive vice president of sales with InSync Healthcare Solutions. He has more than 20 years in healthcare and technology and manages all company operations, driving its go-to-market strategy and overseeing all sales activities.}