There’s been a strong push for a FHIR standard for information sharing in healthcare. Although a standard built on application programming interfaces (APIs) using data standards like FHIR is a step in the right direction, in today’s healthcare ecosystem, there’s a broader impact to consider.
The industry avoided a major health equity setback when the U.S. Department of Health and Human Services (HHS) Office of National Coordinator (ONC) nixed prescriptive language in the HTI-1 rule, passed in December, that would have incentivized providers to share information from the EHR using direct secure messaging or a Health Level Seven (HL7®) International Fast Healthcare Interoperability Resources (FHIR®) structured messaging. Language in the proposed rule specifically stated that providers would be penalized for the use of digital cloud faxing to send and receive information from the certified EHR. Such a move would have had significant implications for smaller care settings like post-acute facilities that treat our most vulnerable patients. These are providers that weren’t eligible for EHR implementation incentives and thus lack the advanced infrastructures of those that were.
It’s not the first time the industry has seen efforts to require healthcare providers and health plans to leverage FHIR-only communications to share data. In fact, the final rule on prior authorizations, released in January, requires certain payers to implement the FHIR standard for prior authorization APIs.
But pigeonholing providers to specific communication methods—FHIR, HL7, X12 and direct secure messaging—hampers the ability to exchange information with healthcare’s “digital have nots,” organizations that have lacked the resources to make the transition on their own. These include some facilities, like home health, assisted living, most birthing centers, substance use disorder clinics, skilled nursing facilities, and more.
While we agree that structured data exchange is important to facilitate 72-hour turnaround for urgent prior authorizations, defining specific prescriptive mechanisms (e.g., FHIR or X12) for exchanging this data–rather than requiring the data be freely exchanged–is a step in the wrong direction for inclusion of all care settings.
In fact, over 1,500 comment letters were sent to the ONC during the open proposed rule stage, many of them stating that the timeline for implementation of FHIR APIs is too short and that the implementation needs to be observed over years to understand the roadblocks. That urging by many respected stakeholders did result in the final rule date being pushed back a year. When this type of standard works seamlessly, we can all communicate using structured data. But unlike the airline industry, which ditched paper tickets for structured content, the healthcare industry is much more complicated with patients’ lives at stake.
Flexibility Matters for Small Facilities
Not all is lost in the ability to move the industry forward to structured data. The ability to effectively transmit patient data across the care continuum depends on an FHIR-friendly go-between—one that can receive unstructured data from healthcare’s digital have-nots and transform it into an FHIR message. These interoperability companies serve as translators and true enablers.
It’s a solution that makes more sense than enacting more regulation around how small providers should meet standards for data interoperability. Just as important, pragmatic technology exists to facilitate these efforts using a service most small providers already own: digital fax.
Today, one of the biggest stumbling blocks to achieving health equity is an inability to move data between healthcare providers from care settings that have technology to providers that don’t. We have to ensure continuity of care and data to support better outcomes. It’s an issue that is especially apparent in rural communities, where some IT experts say lack of data interoperability is a rural health disparity. It’s also a major impediment to improving health outcomes for vulnerable populations.
Most of the data healthcare providers need to make informed decisions regarding the care and resources patients need is unstructured data: data that isn’t captured in structured data fields in the electronic medical record. This type of data can range from information captured in clinicians’ notes as well as data in digital faxes, PDFs, handwritten notes or images.
Research suggests the ability to streamline integration of healthcare data between the EHR and other systems could empower healthcare organizations to make the right connections for improved health. In doing so, healthcare’s key stakeholders could put actionable patient data in the hands of providers as well as Social Determinants of Health (SDoH) services such as food banks, social workers, charitable housing associations and other community providers that aim to meet patients’ whole-health needs.
Digital fax provides a viable option for effective data exchange across care settings. With the application of artificial intelligence (AI) and natural language processing (NLP) combined with data exchange technology like digital faxes, vital patient information can be intelligently extracted and sent to providers directly within their workflows via the EHR. The impact: a level of interoperability that improves patient outcomes—and one that smaller care settings can afford, especially in partnership with a larger provider.
It’s Time for a More Inclusive Approach
As much as fax is still a dirty word in healthcare, digital cloud fax—when combined with AI and NLP—is a powerful level for advancing data interoperability and health equity.
Allowing for tech innovations that transform unstructured data into structured data in small care settings will facilitate the move toward FHIR without sacrificing health equity. Such innovations can also serve as a bridge to connect healthcare facilities that aren’t able to communicate with larger health systems via direct secure messaging or an HL7® FHIR® message.
It’s time to stop trying to dictate how healthcare’s digital have-nots can achieve interoperability and start equipping providers with the right tools for effective data exchange.
About Bevey Miner
Bevey Miner is the executive vice president, of healthcare strategy and policy for Consensus Cloud Solutions. Prior to this, Bevey was the Managing Partner at HatchEvo, where they successfully rebranded the consulting company and recruited a capable team. Bevey has also held leadership positions at NextGen Healthcare, Practice Fusion, HealthLoop, and Allscripts, where they were responsible for managing various divisions and developing new strategies. Additionally, Bevey has worked at MarketPoint Healthcare Consulting, Tenzing Group, Ginger.io, and Healthvision, contributing to market analysis, strategic planning, business development, and branding. Their expertise lies in digital health, HIT advisory, strategic partnerships, and payer and government relations.