Interoperability enablement solves the challenges healthcare ecosystem is facing with information sharing among all the stakeholders of patient health, by enabling timely implementation of CMS Interoperability Regulations and by integrating various interoperability and information sharing initiatives to maximize the benefits in Clinical and Financial information sharing across the Healthcare Value Chain.
Industry initiatives such as Da Vinci, Argonaut, CARIN, Vulcan, and Gravity are pivotal in leveraging the HL7 FHIR standard to construct robust interoperability frameworks.
These initiatives are essential for healthcare enterprises aiming to comply with evolving interoperability mandates such as 9115 and 9123. It's crucial for organizations to develop roadmaps aligned with the standards and implementation guidelines set by these projects.
Adopting a FHIR-based connected health ecosystem ensures the flexibility and adaptability needed for current compliance and future sustainability in healthcare interoperability.
Connected Health framework should factor in all the primary and supporting business drivers such as the following,
- CMS Interoperability mandates (CMS 9115 & 9123) accelerating the need for adoption
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- Natural alignment of Interoperability program with Digital Transformation Initiatives such as API First, Cloud First, Process Automation, Blockchain, IoT/IoMT and Embedded Analytics at enterprise level
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- Patient-centric care and Consumerism driving data transparency and patient ownership of data
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- Acceleration of Virtual Care and Remote Patient monitoring needs since the Pandemic
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- Healthcare organizations started adopting APIs at enterprise level, powered by cloud technologies
- Meaningful Use requirements led to EHR adoption building the foundation for interoperability
- 21st Century Cures Act recommending no information blocking and called out patients as the owners of their data
- Value based contracts making providers take a forward-looking, strategic approach and leverage patient data for better outcomes.
- Population Health Management, Chronic Care Management and Leveraging SDoH data further drives the transformation.
- Significant potential to improve process efficiencies through Patient Information sharing.
- Claims attachment sharing- ~25-30% reduced spend in claims operations.
- Prior Auth- ~30-40% reduction in RCM spend.
A view of how connected health solution framework would enables Payer and Provider Integration with the Core components is depicted in the below diagram.
Figure 2 Indicative Solution Framework
The FHIR Transformation Engagement Framework facilitates healthcare organizations in adopting FHIR standard. Different clients are at different stages of their adoption and evolution, and hence having the correct engagement approach allows to transform their journey from any stage. It encompasses assessment of the as-is state, defining To-Be state, Build & Implementation, followed by Validation and governance to ensure seamless integration and data interoperability across systems.
Figure 3 FHIR Transformation Framework
Conclusion
The connected health on FHIR framework represents a pivotal advancement in healthcare interoperability. By leveraging the HL7 FHIR standard and industry initiatives like Da Vinci, Argonaut, CARIN, Vulcan, and Gravity, healthcare organizations can achieve seamless data exchange and integration. This framework enhances operational efficiencies and patient care and ensures compliance with evolving regulatory mandates. Embracing FHIR empowers healthcare enterprises to navigate the complexities of modern healthcare delivery, fostering a future-ready ecosystem that prioritizes interoperability, flexibility, and improved patient outcomes.