The federal website funded by U.S. Centers for Medicare & Medicaid Services notes, “the lack of seamless data exchange in healthcare has historically detracted from patient care, leading to poor health outcomes, and higher costs”.
The essential step to digitally transforming healthcare is enabling “different information systems, devices and applications (systems) to access, exchange, integrate and cooperatively use data in a coordinated manner,” according to the Healthcare Information and Management Systems Society (HIMSS), the member association committed to transforming the global health ecosystem.
The U.S. government grasped these principles and began to act on them during the Obama Administration and since 2015 has ushered in a series of regulations that encourage and enable the use of standardized APIs as the key to interoperability.
The Fast Healthcare Interoperability Resources (FHIR®), a Health Level 7 (HL7) standard for exchanging healthcare information electronically. HL7 is a member of HIMSS and FHIR provides standardization for application programming interfaces (APIs).
The latest development is the publication of Trusted Exchange Framework and the Common Agreement (TEFCA) published by the U.S. Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health Information Technology (ONC). The framework is a set of non-binding but foundational principles for health information exchange across the U.S., as recommended in the 2016 21st Century Cures Act.
In 2019, the ONC estimated that more than 80% of hospitals and two-thirds of clinicians already use electronic health record systems (EHRs) that leverage FHIR.
This statistic needs to be regarded with some caution though as a report published by Pew in January 2021 found that the APIs are not being as widely used as they could be, with just three use cases accounting for most of the deployments – patient access, clinical decision support and provider-to-provider data exchanges. It found APIs were barely used at all to exchange data between health providers treating the same patient.
Competition not compliance
This illustrates that while government policy has been critical in helping enshrine standardized APIs at the heart of health ecosystems, health organizations of all kinds and sizes should not be regarding their adoption only as a matter of compliance or only for isolated uses, to reap the full benefits.
Standardized APIs that build on FHIR are game changers for patients and for health organizations too, from delivering greater operational efficiencies and better patient outcomes to creating new business models and monetization options.
Having said that, it is important to note that the act of deploying standardized APIs does not guarantee success. They can only fulfil their greatest potential if they must be used everywhere they can be used, every time, and implemented in a consistent way to ensure replicated, seamless interoperability for the exchange of data. The approach needs to be holistic not piecemeal, which is not to say everything can be addressed at once.
Successful implementation requires a comprehensive and well-executed API strategy and governance, starting with the vision – the desired outcomes from an organization’s widespread adoption of FHIR-based APIs – never the technology.
Get a jump start
Given how much there is to consider, the fastest way to see the benefits of FHIR-based APIs is by getting specialist help that is expert in its use of proven tools. Torry Harris Integration Solutions (THIS) has just launched a suite of FHIR readiness services and solutions.
A good place to start is with a THIS FHIR-readiness Assessment because to reach a destination – the strategic vision for desired outcomes – you need to know where you are to start with. The assessment involves a study of the organization’s healthcare IT landscape including applications, technologies, infrastructure, policies, challenges and so on.
The next step is to create a roadmap for a step-by-step transformation of components to adhere to FHIR standards, then define an execution plan by breaking down activities, and making decisions such as build versus buy for selected legacy components. Another important aspect is to identify candidates for cloud-enablement to improve business agility, whether those entail shifting servers to virtual machines, adopting third-party software-as-a-service (SaaS) applications, etc.
It is critical to identify skills and competencies required for your IT team compared with what they have now, and define the best way to fill the ‘gaps’.
One option to get started is for THIS to run a Healthcare Digital Transformation Workshop, where IT and business stakeholders can discuss and agree on the strategy and roadmap, as well as decide which areas should be prioritized for modernization, compliance and as new revenue streams.
A workshop is also a good environment in which to identify opportunities for participating in healthcare ecosystems, for example the roles involved, whether provider or consumer. Also identifying customer value streams and what the best partners’ profiles would be for your organization.
API monetization strategy is a critical element of the digitalization process, along with data points, price plans and more. By the end of the workshop, attendees should have a transformation plan mapped out.
Mix and match services
THIS has long experience of integration and transformation projects of all kinds, and other FHIR Enablement Services, in brief, include:
- Moving legacy to cloud native applications using the best combination of SaaS applications and microservices for each customer, and the API-enablement of key IT capabilities, customers’ data and so on to comply with FHIR.
- Implementing API management technology, to ensure customers have the right tech stack for securely exposing their FHIR-compliant data and functional blocks.
- Support for API platforms, Digital Marketplace and other healthcare applications which involves defining operational metrics like service level agreements and key performance indicators for both operations and support.
Interoperability Kit for Healthcare Digital Exchange
In terms of products and solutions, THIS offers the Interoperability Kit for Healthcare Digital Exchange, which combines proven API tools and FHIR-specific data models and templates, plus legacy transformation patterns and principles.
Interoperability Kit for Healthcare Data Exchange
THIS’ DigitMarketTM API Manager seamlessly manages all of an organization’s API cycles: Industry analyst Ovum (now Omdia) said in a report that DigitMarketTM “Offers digital ecosystem enablement in one package”.
Coupler offers an alternative, simpler method to build microservices using a low-code, no-code approach and can accelerate microservices initiatives by 40%.
AutoStub® can speed up API development by up to 20% as it can reduce build time by designing, prototyping, documenting and testing APIs using a functional mock that allows developers to work with APIs before they are fully implemented.
Deplomatic can reduce governance costs by 35% as an API-first, integration-friendly tool for quickly creating and maintaining cloud native data environments that run on containers. It and ensures deployments are less error-prone and more repeatable.
AutomatonTM can reduce test effort by 30% as multiple award-winning, no-code tool that automates testing of data interfaces, APIs, user interface components and all the other elements of an application. Users can run tests without coding knowledge.
The schematic below shows how the tools could fit into a healthcare data exchange scenario.
Fitment of DigitmarketTM Tools - Healthcare Data Exchange
As Micky Tripathi, Ph.D., national coordinator for health information technology, noted at the launch of TEFCA, “Simplified nationwide connectivity for providers, health plans, individuals, and public health is finally within reach.”