By Jason Warrelmann, vice president global services and process industries, UiPath.
FHIR, or Fast Healthcare Interoperability Resources, are quickly being adopted on a massive scale. While only 24% of healthcare companies currently utilize application programming interfaces (APIs) at scale, according to recent data, FHIR APIs will become widespread by 2024.
The data also shows that more than 50% of providers (out of 400 surveyed stakeholders) said they are consuming and producing a large number of APIs. However, some players lag behind, with 43% and 37% saying they consume and build APIs, respectively. That being said, however, 67% of providers and 61% of players expect their respective organizations to utilize APIs at scale as soon as 2023.
But what exactly does FHIR do?
Developed by Health Level 7, or HL7, FHIR has quickly become the standard for representing and exchanging health information. FHIR enables how healthcare information can be exchanged between different computer systems regardless of how it is stored. It allows this information, including clinical and administrative data, to be available securely to those who need access to it and who have the right to do so for the benefit of a patient receiving care. However, FHIR APIs are not easy for businesses to adopt, as it is mostly driven by the need for compliance with interoperability rules today. For healthcare providers, this means several steps of preparation before they can be fully FHIR-ready.
FHIR-enabled automation can help make this adoption easier, leaving the preparation to software robots. Automation software makes sharing data and information between teams more seamless, ensuring everyone is on the same page when it comes to FHIR APIs. FHIR-enabled automation also ensures compliance and streamlines important processes, reducing the cost of FHIR adoption and making it faster and more efficient.
Here are the three ways FHIR-enabled automation can simplify the FHIR adoption process:
By Andrew A. Brooks, M.D., chief medical officer, TigerConnect.
Information is the healthcare industry’s core, from paper to digital record keeping. Healthcare organizations and physicians have relied on charts, treatment plans and other means of records to provide the highest quality of care they can offer. In the 21st century, providers need unrestricted access to holistic data to streamline record-keeping, reduce costs, and better collaborate as treatment teams advance patient care. This access to vital information is becoming more critical as digital healthcare information rises along with the rise in EHR integration.
By current estimates, nearly 30 percent of the world’s data is being generated in healthcare – with no signs of slowing down, this figure is expected to reach 36 percent by 2025. According to a 2019 Centers for Disease Control (CDC) survey, almost 90 percent of office-based physicians responded that they are leveraging EHR systems in their office-based practice. Information availability is only part of the healthcare equation. Data accessibility and interoperability are another.
When roadblocks to information are present, it can create unnecessary challenges for hospitals and treatment teams to do their jobs. These challenges in treatment and care can lead to poor clinical communication and collaboration – reducing the quality of patient care and driving costs upward. In an industry such as healthcare, smooth communications are essential both between providers and patients as they attempt to navigate doctor’s offices, hospitals, and other care facilities. Unfortunately, interoperability and access to information aren’t easy.
Information Blocking and its Impacts on Patient Care
Information blocking often refers to the interference of access, use or exchange of electronic health information. In most cases, information blocking is caused by the use of proprietary technology systems that are unable to interoperate or communicate with one another. When information blocking does occur, patient data necessary for care can be sent or received in an untimely manner or can be transmitted inaccurately. The fact is that most electronic data is still locked in silos across disparate providers. According to a study reported on by the AJMC, nearly 75 percent of physicians feel they lack sufficient information about their patients. The demand for seamless access to healthcare information is one of the driving forces behind the 21st Century Cures Act – which expanded its scope in October.
The 21st Century Cures Act & The Power of Data to Improve Patient Care
When healthcare providers have access to data, they can dramatically improve patient care. This is why many are asking the Department of Health and Human Services (HHS) for additional clarity on new federal information blocking regulations set in motion in October.
The original 21st Century Cures Act held health IT vendors, providers, and health responsible for information exchanges to better provide patient access to health records with 3rd party applications – banning the blocking of health information sharing. But this applied only to a limited set of data. Under the expanded regulations, patients will get electronic access to their records without limitations. So, what do providers and patients need to know, and how can they better align with these new regulations?
Greenway Health launches the Greenway’s 21st Century Cures Academy to serve as a resource center for providers navigating the 21st Century Cures Act, its legal requirements, and its effects on the entire healthcare industry. Greenway’s 21st Century Cures Academy is a free resource available to anyone looking to learn more about the 21st Century Cures Act and its requirements.
The 21st Century Cures Act aims to improve the healthcare ecosystem and empower patients by requiring healthcare provider interoperability and patient data access for both patients and providers. The bipartisan legislation will require all healthcare providers, healthcare IT developers, and health information exchanges (HIEs) to be 21st Century Cures Act-compliant by Dec. 31, 2022.
“We consistently heard providers and industry leaders voice concerns and confusion surrounding the 21st Century Cures Act and its future requirements for compliance,” said Dr. Michael Blackman, Chief Medical Officer at Greenway Health. “We knew we needed to create the 21st Century Cures Academy as an educational series and resource center aimed to alleviate confusion, guide providers, and highlight the benefits this legislation will have on the entire healthcare system.”
Greenway’s 21st Century Cures Academy resource center provides easy-to-digest materials including checklists, quick guides, webinars, and other resources to assist healthcare providers in discovering the value the 21st Century Cures Act has to offer their practice.
This report describes examples of electronic health record (EHR) related burden, as well as strategies and recommendations that HHS and other stakeholders can use to help clinicians focus their attention on patients rather than paperwork, when they use health information technology (health IT).
“Usable, interoperable health IT is essential to a healthcare system that puts the patient at the center, like President Trump has promised,” said HHS Secretary Alex Azar. “We received feedback from hundreds of organizations and healthcare providers on this new burden-reduction strategy, and the input made clear that there are plenty of steps still necessary to make IT more usable for providers and maximize the promise of electronic health records.”
The development of the report, required under the 21st Century Cures Act, was led by the HHS Office of the National Coordinator for Health Information Technology (ONC) in conjunction with the Centers for Medicare & Medicaid Services (CMS). The initial draft, issued in November 2018, represented HHS’s assessment and response to feedback heard from a wide variety of health IT stakeholders, from practicing clinicians to health IT developers.
The report released today reflects additional input from the more than 200 comments submitted in response to the draft strategy and recommendations. The report outlines three primary goals and offers recommendations to:
Reduce the effort and time required to record information in EHRs for health care providers when they are seeing patients;
Reduce the effort and time required to meet regulatory reporting requirements for clinicians, hospitals, and health care organizations; and
Improve the functionality and intuitiveness (ease of use) of EHRs.
“The strategy we are releasing today takes a hard look at ways that the federal government and stakeholders can work together to reduce the administrative and technological burdens experienced by healthcare providers,” said Don Rucker, M.D., national coordinator for health IT. “Patients will benefit from these efforts because their physicians will spend more time focused on them instead of their keyboards.”
Specifically, ONC and CMS looked at four key areas and offered strategies to address each area:
Clinical documentation
Health IT usability (or ease of use of health IT tools and systems)
Federal health IT and EHR reporting requirements
Public health reporting (including coordination with prescription drug reporting programs and electronic prescribing of controlled substances).
Seema Verma
“The taxpayers made a massive investment in EHRs with the expectation that it would solve the many issues that plagued paper-bound health records,” said CMS Administrator Seema Verma. “Unfortunately – as this report shows – in all too many cases, the cure has been worse than the disease. Twenty years into the 21st century, it’s unacceptable that the application of Health IT still struggles to provide ready access to medical records – access that might mean the difference between life and death. The report’s recommendations provide valuable guidance on how to minimize EHR burden as we seek to fulfill the promise of an interoperable health system.”
The report explains that different types of administrative burden can affect different healthcare providers, but is focused on those healthcare providers that are directly involved in delivery of patient care. Those may include physicians, nurses, and other clinical staff; practice managers and other administrators immediately engaged in the management of care delivery; and care delivery institutions, such as hospitals.
The American Health Information Management Association (AHIMA) sent a joint letter to Congressional leaders today voicing concerns that certain provisions of the Office of the National Coordinator for Health Information Technology’s (ONC’s) recent 21st Century Cures Act (Cures) proposed rule on information blocking jeopardizes goals to foster a healthcare system that is interoperable, patient-engaged and reduces burdens for those delivering care.
The letter, co-signed by seven organizations representing the nation’s clinicians, hospitals, health systems and experts in health informatics and health information management, outlines several recommendations aimed at furthering the objectives of Cures, while ensuring that the final regulations do not unreasonably increase provider burden or hinder patient care.
“We support the intent of the Cures Act to eradicate practices that unreasonably limit the access, exchange and use of electronic health information for authorized and permitted purposes that have frustrated care coordination and improvements in healthcare quality and efficiency,” said AHIMA CEO Wylecia Wiggs Harris, PhD, CAE. “However, in light of the lessons learned from the meaningful use program, we believe it is crucial that we get this right. We look forward to discussing the details of these recommendations with congressional staff and ONC.”
Recommendations outlined in the letter include:
Additional rulemaking prior to finalization: ONC should seek further input from impacted stakeholders on issues including modifying the information blocking proposal to ensure that the requirements and exceptions are well-defined and understandable, and clinicians, hospitals and health information professionals are not inappropriately penalized if they are unable to provide a patient’s entire electronic health information through an application programming interface (API).
Enhanced privacy and security: The proposed rule does not sufficiently address Cures’ directives to protect patient data privacy and ensure health IT security. It is imperative that the Committee continues its oversight of privacy and security issues that fall outside of the Health Insurance Portability and Accountability Act (HIPAA) regulatory framework. This includes ensuring certified APIs include mechanisms to strengthen patients’ control over their data—including privacy notices, transparency statements and adherence to industry-recognized best practices.
Appropriate implementation timelines: ONC should establish reasonable timelines for any required use of certified health IT (CEHRT). Providers must be given sufficient time to deploy and test these systems, which must take into account competing regulatory mandates.
Revised enforcement: The U.S. Department of Health and Human Services should use discretion in its initial enforcement of the data blocking provisions of the regulation, prioritizing education and corrective action plans over monetary penalties.
For additional information on these recommendations, click here.
Signatories of the letter include:
American Health Information Management Association (AHIMA)
American Medical Association (AMA)
American Medical Informatics Association (AMIA)
College of Healthcare Information Management Executives (CHIME)
Federation of American Hospitals (FAH)
Medical Group Management Association (MGMA)
The American Medical Association (AMA) and six other organizations have asked two congressional committees to use their oversight of the 21st Century Cures Act to improve interoperability and empower patients with meaningful health information while ensuring data is safe and secure. The letter arrives as the administration is drawing up its plans to implement the law and adopt information blocking rules.
The AMA appreciates several of the administration’s proposals, particularly related to electronic health record (EHR) certification, EHR application programming interfaces (APIs), and modifying EHR vendor business practices and behaviors.
There are, however, numerous complex, counter-intuitive proposals that jeopardize the goals Congress outlined in the Cures Act. Concerningly, many of the administration’s proposals will dramatically affect patient privacy and safety as well as as data security. The proposals also will add to physician burden and burnout.
“The administration owes it to patients, physicians, Congress and our nation to listen and act on these concerns,” said Jesse M. Ehrenfeld, M.D., chair of the AMA’s Board of Trustees. “We still have a chance to get these policies right. It is possible to improve access to medical information while promoting privacy and transparency.”
The U.S. Department of Health and Human Services (HHS) today issued for public comment draft two of the Trusted Exchange Framework and Common Agreement (TEFCA) that will support the full, network-to-network exchange of health information nationally. HHS also released a notice of funding opportunity to engage a non-profit, industry-based organization that will advance nationwide interoperability.
Specifically, the documents being released for comment are: (1) a second draft of the Trusted Exchange Framework (TEF), (2) a second draft of the Minimum Required Terms and Conditions (MRTCs) for trusted exchange, and (3) a first draft of a Qualified Health Information Network (QHIN) Technical Framework. These documents will form the basis of a single Common Agreement that QHINs and their participants may adopt. This Common Agreement will create baseline technical and legal requirements for sharing electronic health information on a nationwide scale across disparate networks.
Alex Azar
“The seamless, interoperable exchange of health information is a key piece of building a health system that empowers patients and providers and delivers better care at a lower cost,” said HHS Secretary Alex Azar. “The 21st Century Cures Act took an important step toward this goal by promoting a national framework and common agreement for the trusted exchange of health information. We appreciate the comments and input from stakeholders so far and look forward to continued engagement.”
In developing a TEFCA that meets industry’s needs, HHS’ Office of the National Coordinator for Health Information Technology (ONC) has focused on three high-level goals:
Provide a single “on-ramp” to nationwide connectivity;
Ensure electronic information securely follows you when and where it is needed; and
Support nationwide scalability for network connectivity.
ONC will maintain the TEF, while a non-profit, industry-based organization, known as the Recognized Coordinating Entity (RCE), will be awarded funds to develop, update, implement, and maintain the Common Agreement. Through this effort, ONC will define the minimum required terms and conditions needed to bridge the current differences among data sharing agreements that are preventing the flow of electronic health information. The industry-based RCE will be tasked with developing additional required terms and conditions necessary to operationalize the Common Agreement and meet the interoperability requirements of the 21st Century Cures Act.
The FDA released guidance last year noting that electronic health records (EHRs) have the potential to improve clinical trials, leading to greater safety and efficacy. But tapping that potential, according to the agency, requires interoperability — the ability of two or more products, technologies or systems to 1) exchange information, and 2) to use the information that has been exchanged without special effort on the part of the user.
The healthcare industry, driven by meaningful-use requirements, is focused on wider efforts to promote interoperability. Many of them emphasize technology, including advances such as Fast Healthcare Interoperability Resources (FHIR) tools and Substitutable Medical Applications, Reusable Technologies (SMART) standards. But while the technology is crucial, it is equally as important to recognize the group of stakeholders who could play a critical role in making systems more interoperable, and thus improve the clinical trials process:
The patients themselves.
Interoperability
Interoperability has the potential to help increase care coordination, improve safety, support patients in making the most informed healthcare decisions, reduce costs, and help public health and health promotion efforts. In addition, interoperability can have a role in drug development, as the 21st Century Cures Act mandates that the FDA include Real-World Data (RWD) — data gathered during routine clinical care – in regulatory decision making. This RWD can be in part derived from the EHR-generated data, standardized and shared through the interoperability process.
The growing availability of information (digital health data is increasing by 48 percent each year) creates the potential for better patient care, including improved clinical trials. Unfortunately, despite strides made in interoperability, data in medical records are still too often packaged in ways (i.e., handwritten notes and medical device feeds) that are hard to share or standardized.
On Tuesday, March 26, the Senate health committee will hold a hearing on implementation of the electronic health information provisions in the 21st Century Cures Act.
In the Cures Act, Congress took steps to help improve the exchange of electronic health information. Last month, the Department of Health and Human Services (HHS) released two rules to define information blocking—so it is clear when one system is purposefully not sharing information with another—and to give patients more control over their records and providers more information so they can better treat their patients. This hearing will be about the proposed new rules and efforts to improve electronic health records and make health information more accessible.
Chairman Lamar Alexander (R-Tenn.) said of the new proposed rules: “These proposed rules remove barriers and should make it easier for patients to more quickly access, use, and understand their personal medical information. It should also unleash new ways of helping doctors and other medical providers to make sense of that information in ways that lead to better health care experiences, better outcomes, and lower costs for patients. Our committee will continue careful oversight of these new rules which affect almost every American and are an important result of the bipartisan 21st Century Cures Act.”
The Senate health committee had six hearings in 2015 to explore ways to get our nation’s system of health information technology out of a ditch and make it useful for doctors and patients. The committee then authored the 21st Century Cures Act which directed HHS to make proposals to improve electronic health records.
The 2019 HIMSS Annual Conference may be over, but that doesn’t mean an end to the pressing challenges and trends discussed at Orlando’s Orange County Convention Center. More than 42,500 people attended the conference — the majority of whom were C-suite executives and HIT professionals taking full advantage of the healthcare IT industry’s largest opportunity for networking, product promotions, continuing education and major announcements.
As always, there were a few subjects during HIMSS19 that generated significant buzz. Here are four of those trends that will remain key topics throughout the next year:
Healthcare data exchange
The release of two long-anticipated proposed rules on information blocking came just as HIMSS19 convened. The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) unveiled proposals that would require healthcare providers and plans to implement open data sharing technologies to support transitions of care. The first focuses on standardized application programming interfaces (APIs) and carries forward provisions from the 21st Century Cures Act.
Those associated with Medicaid, the Children’s Health Insurance Program (CHIP), Medicare Advantage and Qualified Health Plans in the federally-facilitated exchanges would have to provide patients with immediate electronic access to medical claims and other health information by 2020. Under a latter proposal, health information exchanges (HIEs), health IT developers and health information networks (HINs) can be penalized up to $1 million per information blocking violation, but providers are not subject to fines.
The goal of the proposals is to consider care across the entire continuum, giving patients greater control and understanding of their health journeys. This is interesting, given that HIMSS attendees who responded to Stoltenberg Consulting’s seventh annual HIT Industry Outlook Survey noted “lack of system interoperability” as one of their biggest operational burdens, and “leveraging meaningful patient data” as the IT team’s most significant hurdle this year. Thus, overcoming these challenges to meet the newly proposed mandates will likely dominate discussions during the remainder of 2019.
As part of the ongoing efforts to strengthen the relationship between patients and their doctors, the U.S. Department of Health and Human Services (HHS) issued the 
