The Digital Health Transformation: Where Does FHIR® Fit?

To reduce administrative workloads and overhead, minimize provider abrasion, meet evolving patient/member demands, and support compliance with regulatory mandates, healthcare leaders need to rethink their approach to interoperability.

In part one of this series, we explained the importance of moving away from a “compliance-first” mindset and instead thinking of interoperability as an enterprise capability that can play a foundational role in your long-term operations. We call this approach “strategic interoperability”—and in this article, we’ll discuss FHIR’s role in this strategy.

The U.S. healthcare industry is in the midst of a difficult period. Healthcare organizations are working to achieve the quadruple aim of improving population health, delivering better patient experiences, reducing costs, and supporting provider well-being—while also navigating increasing budgetary constraints.

An interoperable healthcare system can support all of these objectives, and regulatory mandates like CMS-0057-F and CMS-9115-F are intended to nudge the industry in that direction. But while compliance is often a key driver of interoperability investments, it’s not the only reason to invest—and healthcare leaders who can’t see that are missing the forest for the trees.

A Collective Approach to Interoperability

By moving to value-based care, healthcare payers and providers can collaborate more effectively to reduce provider abrasion and improve satisfaction, which in turn drives better member outcomes and lower care costs. However, these benefits aren’t achievable without a truly interoperable system that allows healthcare data to be seamlessly and securely exchanged, integrated, and applied across all care settings and between all relevant stakeholders.

It’s no secret that the shift to value-based care has taken longer than anticipated. According to the Healthcare Payment Learning and Action Network (HCPLAN) 2023 APM Measurement report, 40.6% of healthcare payments still come through fee-for-service models with no link to quality or value. A key reason for this failure to achieve widespread adoption of value-based care is because the healthcare industry has not yet reached the level of interoperability needed to fully support it.

Healthcare leaders have (understandably) made interoperability investments based on satisfying regulatory mandates and fulfilling their own internal use cases, rather than on the needs and processes of their external partners and other organizations. But when every healthcare organization only invests in interoperability to achieve compliance and improve internal information exchange, the result isn’t a single interoperable system but a series of interoperable systems.

Data moving seamlessly within siloed systems is great for the organizations controlling those systems. Unfortunately, it doesn’t bring us closer to what the Healthcare Information and Management Systems Society (HIMSS) calls organizational interoperability. HIMSS defines organizational interoperability as “includ[ing] governance, policy, social, legal, and organizational considerations to facilitate the secure, seamless, and timely communication and use of data both within and between organizations, entities, and individuals.”

In other words, there has to be connective tissue between organizations that enables them to exchange data with any stakeholder across the entire healthcare ecosystem. That’s where Fast Healthcare Interoperability Resources (FHIR®) comes in.

What Is FHIR?

Healthcare organizations use a variety of data formats, designed and governed by more than 40 different standards development organizations (SDOs). Some formats are more common than others, but every organization uses its own unique software systems, processes, and data formats, and getting everyone to agree on a single standard for each would be nearly impossible. With FHIR, they don’t have to.

Designed with collaboration and extensibility in mind, FHIR enables the ingestion of data in any format and converts it to a standard that can be shared with any organization, regardless of the formats, systems, or processes in use by the recipient. FHIR’s inherent flexibility makes it a powerful tool that can help support organizational interoperability. But to achieve strategic interoperability, healthcare leaders will need to choose their FHIR investments wisely.

FHIR’s Role in Strategic Interoperability

In our experience, interoperability is about enabling information exchange and multi-party workflows within and across organizations, regardless of standard or protocol. If you’re trying to achieve strategic interoperability, each investment should aim to maximize the number of value-added, non-compliance use cases for your organization.

FHIR’s versatility makes it an ideal standard not only to promote organizational interoperability, but to enable organizations to maximize the utility of their existing EDI investments as well. Forward-thinking healthcare leaders are taking a “FHIR-first” approach, making it a priority to ensure their data is in FHIR format.

To achieve strategic interoperability and maximize ROI, however, healthcare leaders need to take advantage of everything else FHIR can support, including:

• More efficient workflows – Spending less time on data retrieval reduces administrative workloads while supporting automation of manual processes
• Ease of implementation – FHIR’s use of open standards and APIs makes it easier to implement in any system
• Better scalability – FHIR is designed to be extensible and scalable, enabling organizations to adapt more easily to evolving business priorities
• Earlier intervention – FHIR simplifies the process of data sharing for public-health purposes, enabling organizations to intervene earlier when their patient populations’ needs change
• Clinical decision support – Structured and organized patient data is easier to exchange between EHRs and allows providers to more quickly access and utilize patient data.

Each of these potential use cases can add significant value beyond compliance, but they all depend on fast, seamless data exchange within and across organizations, which makes FHIR an ideal standard to support them. Although FHIR plays an important role in strategic interoperability, healthcare leaders must avoid thinking about interoperability through the lens of features (e.g., FHIR-based APIs) or standards, like FHIR itself.

We find it helpful to think of strategic interoperability as a destination: your interoperability investments are the car you’ll take to get there, and FHIR is the engine. The 57F mandate helps ensure that every healthcare organization is using the same engine—but as we’ll discuss in our next post, a powerful engine means nothing without the right parts around it.