FHIR^® Gateway

The average patient sees 19 doctors in their lifetime. For patients with complex conditions or multiple comorbidities requiring specialist care, that number can be significantly higher. It is essential that their medical information flows seamlessly between providers and their health plan.

Achieving interoperability ensures that patients, providers, and health plans can easily access the right information at the right time to support better patient care and outcomes, reduce errors, and improve operational efficiency.

Healthcare organizations utilize a variety of different systems; unfortunately, many of these systems weren’t designed to work well with others. To bridge the gaps between systems, organizations have traditionally relied on custom interfaces and point-to-point integrations, which are both expensive and time-consuming to maintain.

FHIR establishes a set of standards for data exchange across disparate systems. Utilizing FHIR APIs, enables healthcare organizations to more easily connect and share data without the need for redesigns or customizations.

An API (Application Programming Interface) allows applications to communicate and extract and share data with one another. For an API to work, the data being exchanged needs to be comprehensible to both applications; however, healthcare data has become increasingly complex, and even minor variations in how one application formats data elements can make it unreadable to another application.

FHIR APIs standardize those data elements to ensure that information can be exchanged between different systems regardless of how it is stored or formatted in each system.

The CMS Interoperability and Patient Access Final Rule (CMS-9115-F) requires payers to implement APIs to improve the electronic exchange of healthcare data. CMS later expanded upon these requirements in the Interoperability and Prior Authorization Final Rule (CMS-0057-F), which provided more guidance regarding APIs for patient access, provider access, payer-to-payer data exchange, and prior authorization.

With a compliance deadline of no later than January 1, 2027, health plans must improve their interoperability through the use of APIs. FHIR APIs offer payers the fastest and least resource-intensive path to compliance.