Data is a crucial pillar of healthcare. But more than just the data itself, the flow of data between all stakeholders is what enables everything from care coordination to quality measurement, payment efficiencies, risk management, and other key goals. Yet, the healthcare industry has historically struggled with data exchange due to the lack of aligned interests caused by a third-party payer system and the predominance of proprietary technology. Additionally, data privacy, which all would argue is necessary, has created a significant cultural opposition to data democratization. As a result, our current system creates an unnatural boundary between health and care that is more focused on treating illnesses than supporting broad scale health and wellness.
Though interoperability and the benefits it brings have long been intangible, there is a bright light at the end of the tunnel, and we are starting to move toward it as an industry. That light is burning bright due to the development and support of the FHIR standard, which is opening up how data and technology can be used to shift healthcare into a more aligned and connected system that will ultimately support keeping people healthy while keeping risk and costs down.
The advent of FHIR
While today’s medical records have mostly evolved from paper to servers, they are still more static than free flowing, and their value is locked up in the systems that they are stored in. The good news, though, is that it is widely recognized that making health data more available will move the industry in the right direction. And as has been the case with progress during the tech revolution of the past 30 years, standards have set the foundation for improved operations and innovations previously unattainable. The FHIR data standard is in the class of tech enablement tools and because it was designed specifically for healthcare it is an accelerator that will enable the collection, aggregation, and analysis of information on individuals and populations to give providers, health plans, pharma organizations, and other stakeholders more ways to support patients at a lower cost, with better quality and lower risk.
Healthcare’s data revolution is now officially underway thanks to regulations like the CMS Interoperability and Patient Access Rule and related rulings involving FHIR. In late 2022, the 21st Century CURES Act mandated medical records be accessible to patients via FHIR, and by the beginning of 2023 all providers were required to use FHIR. Though FHIR adoption has been slowed due to political, technical, and cultural obstacles – there has been progress as more and more organizations make the shift and start uncovering what FHIR is capable of.
With the FHIR infrastructure in place and regulations guiding the way, the stage is set for innovation to come. Similar disruption has occurred in other spaces, enabling processes to be faster and more efficient. For example, digital payment apps, like Venmo and Cash App, are driving the fintech revolution and providing an alternative to traditional banking with instant transactions and secure payments. Now is healthcare’s time to undergo the same transformation, and FHIR is making it possible.
FHIR today, FHIR tomorrow
Now that organizations are starting to use FHIR, they are quickly seeing the benefits that this standard can bring in the short term – and even catching glimpses of what it will enable in the coming years. With FHIR, some health plans are using the combination of claims and clinical data to find gaps in care and improved care planning options. The comprehensive nature of the combined data set truly allows for a new and deeper level of actionable insight, and as a result, better business performance.
FHIR is poised to unlock next-level capabilities and business models. Think of any modern consumer experience – it’s digital, intuitive, and makes it easy to save your information (possibly even pulling from other sources to better tailor the experience). It is exciting to think that this could be healthcare’s future. A world where providers, payers, and everyone involved are working to deliver better care for all. FHIR-enabled data would make it possible to create detailed profiles on each patient to paint a comprehensive picture of overall health. These profiles could contain medical data plus lifestyle and behavioral data pulled from health monitoring devices, social media, exercise and health apps, public records, and so on – helping to inform more holistic approaches to support health outcomes while reducing risk and costs.
Modernized, consumer-friendly healthcare experiences would also encourage individuals to participate more in their own journeys, which is a critical element of effective preventative care. For example, plans could use FHIR to access real-time data from wearables/remote monitoring devices and offer members discounts for healthy habits when staying in target range on key health metrics. Just like the devices that car insurance companies use to discount drivers for safe practices, FHIR could help healthcare organizations design new programs that give patients real-time, measurable ways to get involved in their own health outcomes.
Fanning the flames
Many other industries have embraced open-source technology in the name of improving efficiencies and consumer convenience, but healthcare has long been on the sidelines. Now, skyrocketing costs and increasing demands for a better system are shifting the tides whereby healthcare will transition from closed, inefficient systems to open, cloud-based infrastructure.
Large volumes of high-quality data can kick off a self-feeding cycle; the more the data gets used, the more in demand it becomes. That is why it’s crucial for more healthcare organizations to start using FHIR and generate more momentum for this much-needed data revolution. Universal FHIR adoption, along with APIs and open technology, will optimize data exchange across diverse platforms to enable capabilities that healthcare has never seen. Leveraging modern cloud tools allows for reliable, cost-effective infrastructure management for all stakeholders. FHIR, combined with lower barriers to innovation, entrepreneurship, and collaboration around creating richer data sets, will enable a new healthcare model empowering all to achieve their maximum health and wellness potential.
About Joe Gagnon
Joe Gagnon is currently CEO of 1upHealth a cloud-based data interoperability platform that unlocks healthcare data to improve outcomes. He is also an avid blogger, co-host of the Chasing Tomorrow podcast, and a serious endurance athlete.