The great data divide: FHIR standard lights the way

Date: April 23, 2020||   0  Comments

The Interoperability and Patient Access Proposed Rule, part of the MyHealthEData initiative, by the Centers for Medicare & Medicaid Services (CMS) would go a long way toward establishing an interoperable health care system. It’s the FHIR standard, aimed at solving a fundamental challenge for health care: accessing available clinical data to improve the quality and cost of health care services and treatments. Don Johnson, Optum State Government Solutions CTO and Product Lead sat down with Healthcare IT Connect’s Rob Waters to discuss the great data divide.

Q: What are the benefits of data standardization in health care?
Don Johnson: Uniting health data under a common set of standards unlocks opportunities to benefit patients, providers, and payers. Today, there are different data standards used by the public and private sector, requiring additional work to exchange and translate accurately. A common standard for the largest data set – clinical data – would cut administrative and technology costs, along with providing more complete and accurate information that can improve outcomes.

Q: What current hurdles stand in the way?
Don Johnson: Too often, clinical data sets are in incompatible formats or exist on incompatible systems. In the case of an individual patient, that can mean one provider having to fax a patient’s records to another provider—an inefficient process. When looking at entire systems for opportunities to improve care, data conversion and cleansing required can be very expensive.

Q: What is the Centers for Medicare & Medicaid Services proposing to address the issue?
Don Johnson: CMS is considering a new rule requiring the implementation of application programming interfaces (APIs) based on HL7’s Fast Healthcare Interoperability Resources (FHIR) standard. The rule would require FHIR-based APIs be openly published. That would enable third-party applications to provide patients secure and immediate access to their health records.

Q: Aren’t there existing data standards? How would adopting FHIR improve things?
Don Johnson: While existing HL7 standards have been effective in improving data interoperability on the claims side, success has been elusive when it comes to clinical data. One example: a doctor’s notes about progress or challenges a patient may be facing. Those notes don’t translate well into data under current systems. FHIR’s richer set of data elements unlock those notes in digital data exchange so they go with the patient, digitally, from provider to provider. That’s the direct benefit. However, all ancillary and supporting structures and data would also have to support the FHIR standard, driving additional adoption and use.

Q: What entities would be required to conform to the new rule?
Don Johnson: All state and federal Health and Human Services agencies, including Medicare Advantage organizations, state Medicaid and CHIP FFS programs, Medicaid managed care plans, CHIP managed care entities, and QHP issuers in FFEs.

Q: How would adopting the FHIR standard improve health care?
Don Johnson: For patients, adopting FHIR would mean every medical provider they see will have real-time access to what all the other providers have observed, tested, treated, and prescribed. That will result in numerous benefits like preventing adverse diagnoses and reducing emergency room admissions.

For providers, it can mean administrative savings, workflow efficiencies, and access to complete patient data for better diagnosis and treatment.

Payers benefit from all of the above—effective care delivered more efficiently lowers costs.

Q: What is your outlook for the proposed rule?
Don Johnson: From our perspective at Optum and UnitedHealth Group, we’re supportive of standards that help facilitate the exchange of data to lower costs and improve outcomes. We address data exchange problems every day and know what it takes to do it. Standards go a long way to improve data exchange.

BIO:
Don Johnson, Chief Technology Officer and VP of Product, Optum State Government Solutions

Don Johnson has over 20 years’ experience in engineering, architecture and innovation. Most recently, he was senior distinguished engineer for the Optum Advanced Technology Collaborative. In that role, he focused on artificial intelligence, blockchain, and other advanced technologies to drive change to the health care system.

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