Healthcare does not have a data problem. It is a data interoperability opportunity.
This is an exclusive interview conducted by the Editor Team of CIO News with Ankit Kumar Agarwal, Director – IT Delivery Services at NewWave Telecom & Technologies Inc.
What is US Healthcare History?
The history of health care in the United States dates back to colonial times when local practitioners provided medical care to their communities. However, the development of a modern healthcare system in the US has been a gradual process spanning several centuries.
During the late 19th and early 20th centuries, the US saw a dramatic increase in medical knowledge and technological advances. As a result, the field of medicine became more specialized, and hospitals began to play a more significant role in the delivery of health care.
In 1929, Baylor University Hospital in Dallas, Texas, established the first pre-paid health insurance plan in the US, which paved the way for the modern healthcare insurance industry. During the Great Depression of the 1930s, many Americans were unable to afford medical care, and the government responded by creating Social Security and the first public health care programs.
In the 1960s, President Lyndon B. Johnson signed the Medicare and Medicaid programs into law, which provided health insurance to elderly and low-income Americans.
In the 1970s, the federal government began experimenting with HMOs as a way to expand access to healthcare services while containing costs. The Health Maintenance Organization Act of 1973 provided grants and loans to encourage the development of HMOs, and by the late 1970s, HMOs had become a popular alternative to traditional fee-for-service healthcare plans.
In the 1980s and 1990s, healthcare costs continued to rise, and the government implemented a series of reforms aimed at reducing healthcare spending. The Affordable Care Act (ACA), signed into law by President Barack Obama in 2010, is the most significant healthcare reform in recent years. It aims to improve access to health care, reduce health care costs, and increase the quality of care.
Additional Details about US Healthcare Trends can be referenced in the article from “Ankit Kumar Agarwal” (dated December 12, 2022). This article was published at https://distilinfo.com/healthplan/challenges-faced-by-the-healthcare-organizations-in-2022/
How does FHIR help transform the Healthcare Data Exchange?
FHIR stands for Fast Healthcare Interoperability Resources. It is a standard for exchanging healthcare information electronically, developed by the Health Level Seven International (HL7) organization. FHIR uses modern web technologies, such as HTTP, RESTful APIs, and JSON, to enable easy and efficient data exchange between healthcare systems.
FHIR is designed to be modular, meaning that it can be used to exchange specific types of healthcare information, such as patient demographics, clinical observations, and medication orders. This modular approach makes it easier to adopt FHIR incrementally, without requiring a complete overhaul of existing healthcare systems.
One of the key benefits of FHIR is its ability to facilitate data exchange between different healthcare systems, such as electronic health record (EHR) systems, clinical decision support systems, and patient portals. FHIR allows healthcare providers to access and share patient information in a standardized format, improving care coordination and patient outcomes.
Additional details about the use of FHIR in US Healthcare can be referenced in the article from “Ankit Kumar Agarwal” (dated December 19, 2022). US Health IT within the Context of Interoperability, FHIR, and Data Exchange – This article was published at https://distilinfo.com/healthplan/us-health-it-within-the-context-of-interoperability-fhir-and-data-exchange/.
How do Regulations Impact Healthcare Interoperability?
It is important to understand the role of the 21st Century Cures Act, Burden Reduction Rule, and TEFCA on FHIR and its impact on Healthcare Interoperability.
21st Century Cures Act and its impact on FHIR Interoperability
The 21st Century Cures Act is legislation passed by the United States Congress in December 2016. The act aims to accelerate the discovery, development, and delivery of new treatments and cures for diseases, as well as to improve the nation’s mental health system. It also aims to modernize clinical trials, provide funding for medical research, and speed up the FDA drug and medical device approval process.
The act includes several provisions related to healthcare information technology and data sharing, including:
- The establishment of the Interoperability and Information Blocking provisions aims to promote the interoperability of health information systems and prevent information blocking.
- The creation of a national patient identifier system aims to improve patient matching and reduce medical errors.
- The establishment of the Office of the National Coordinator for Health Information Technology (ONC) to promote the development of a nationwide interoperable health IT infrastructure.
- Provisions that support the use of FHIR (Fast Healthcare Interoperability Resources) as a standard for exchanging healthcare information.
- Provisions that support the use of APIs (Application Programming Interfaces) to enable secure and seamless access to electronic health information.
Additional details about the 21st Century Cures Act and its Impact on FHIR Interoperability can be referenced in the article from “Ankit Kumar Agarwal” (dated February 6, 2023). This article was published at https://distilinfo.com/healthplan/21st-century-cures-act-and-its-impact-on-fhir-interoperability/.
TEFCA and its impact on FHIR Interoperability
TEFCA (Trusted Exchange Framework and Common Agreement) is a framework developed by the Office of the National Coordinator for Health Information Technology (ONC) in the United States to promote interoperability among electronic health record (EHR) systems and other health information technology (HIT) systems. The goal of TEFCA is to facilitate the exchange of health information between different systems and providers and to improve the efficiency, effectiveness, and quality of healthcare.
TEFCA is one of several initiatives aimed at improving interoperability in healthcare. Other efforts include the use of standards such as Fast Healthcare Interoperability Resources (FHIR) and the adoption of APIs (Application Programming Interfaces) to facilitate the exchange of data between systems.
Additional details on Can TEFCA Transform Healthcare Interoperability can be referenced in the article from “Ankit Kumar Agarwal” (dated January 24, 2023). This article was published at https://distilinfo.com/healthplan/can-tefca-transform-healthcare-interoperability/
Burden Reduction Rule and its impact on FHIR Interoperability
Patients tend to receive care from multiple providers, leading to fragmented patient health records where various pieces of an individual’s longitudinal record are locked in disparate, siloed data systems. With patient data scattered across these disconnected systems, it can be challenging for providers to get a clear picture of the patient’s care history, and patients may forget or be unable to provide critical information to their providers. CMS is focused on breaking the silos and handling the key issues of Electronic Prior Authorization, Payer-to-Payer Data Exchange, and Payer-Provider Data Exchange to reduce healthcare waste and improve the Healthcare Outcome.
In this rule, CMS requires that the impacted payers (MA organizations, state Medicaid FFS programs, state CHIP FFS programs, Medicaid managed care plans, CHIP managed care entities, and QHP issuers on the FFEs) include information about prior authorizations in the data that are available through the Patient Access API. In addition, it is required that these impacted payers annually report to CMS certain metrics about patient data requests via the Patient Access API.
Additional details on How Burden Reduction Rule Will Transform the FHIR Interoperability Space can be referenced in the article from “Ankit Kumar Agarwal” (dated January 6, 2023).– This article was published at https://distilinfo.com/healthplan/how-burden-reduction-rule-will-transform-the-fhir-interoperability-space/.
How does FHIR Impact the Patient Matching Process?
Patient matching refers to the process of accurately identifying a patient across different healthcare systems and settings. It is a critical aspect of interoperability, as it enables the sharing of patient information between different systems, allowing for more efficient and effective care delivery.
FHIR standards can be used to help solve the patient-matching problem by providing a common framework for the exchange of patient information between different healthcare systems. FHIR defines a set of standard data elements and data structures that can be used to represent patient information, making it easier to compare patient data from different systems and match patients across different systems.
One of the key ways that FHIR can be used to solve the patient matching problem is through the use of the Patient resource. This resource contains a set of standard data elements that can be used to represent patient information, including demographic information such as name, date of birth, and address, as well as other data such as medical record numbers and biometric data. By using the same data elements and data structures to represent patient information, FHIR makes it easier to compare patient data from different systems and match patients across different systems.
Additional details on the Magic of Patient Matching and FHIR can be referenced in the article from “Ankit Kumar Agarwal” (dated February 13, 2023).– This article was published at https://distilinfo.com/healthplan/magic-of-patient-matching-and-fhir/.
How does SMART on FHIR Impact FHIR-based Interoperability?
SMART on FHIR (Substitutable Medical Apps & Reusable Technologies on Fast Healthcare Interoperability Resources) is a set of open standards and specifications that enables developers to create healthcare applications that can be easily integrated with electronic health records (EHRs) systems. It is built on top of the FHIR (Fast Healthcare Interoperability Resources) standard and allows for the creation of “plug-and-play” healthcare apps that can be used across different EHR systems.
SMART on FHIR defines a set of standard Application Programming Interfaces (APIs) and a security model that allows apps to be launched within the context of an EHR system and to access patient data. This allows the apps to be integrated seamlessly with the EHR, providing clinicians with access to additional functionality and data without requiring them to leave the EHR interface.
Additional details on SMART on FHIR and its impact on FHIR Interoperability can be referenced in the article from “Ankit Kumar Agarwal” (dated January 31, 2023).– This article was published at https://distilinfo.com/healthplan/smart-on-fhir-and-its-impact-on-fhir-interoperability/.
How does FHIR work in coexistence with OpenID Connect?
OpenID Connect (OIDC) is an authentication protocol that is built on top of the OAuth 2.0 authorization framework. OIDC provides a way for users to authenticate with an application and share their identity information with that application. This allows the application to authenticate the user and authorize access to protected resources.
OIDC defines a set of standard endpoints, messages, and flows that can be used to authenticate users and share identity information.
OpenID Connect (OIDC) and Fast Healthcare Interoperability Resources (FHIR) are two separate standards, but they can be used together to provide secure and interoperable access to healthcare data.
FHIR is a standard for the exchange of healthcare data, and it can be used to represent patient information, including demographic information, medical records, and other clinical data. OIDC is an authentication and authorization protocol that can be used to authenticate users and authorize access to protected resources.
By using OIDC to authenticate users and authorize access to FHIR resources, organizations can ensure that only authorized users have access to sensitive patient information. OIDC can also be used to provide Single Sign-On (SSO) functionality, which allows users to authenticate once and access multiple FHIR-based systems without having to log in multiple times.
Additional details on the Coexistence of OpenID Connect and FHIR can be referenced in the article from “Ankit Kumar Agarwal” (dated February 23, 2023).– This article was published at https://distilinfo.com/healthplan/coexistence-of-openid-connect-and-fhir/.
How can FHIR transform Clinical Data Exchange?
Clinical Document Exchange (CDex) refers to the process of exchanging clinical documents between different healthcare systems and providers. Clinical documents are electronic records that contain important patient information, such as discharge summaries, progress notes, and care plans. CDex enables healthcare providers to share this information in a consistent and standardized way, which can help improve the quality of care and reduce the risk of errors.
Clinical Document Exchange (CDex) via FHIR (Fast Healthcare Interoperability Resources) is a way of exchanging clinical documents between different healthcare systems and providers using the FHIR standard. Clinical documents are electronic records that contain important patient information, such as discharge summaries, progress notes, and care plans. CDex enables healthcare providers to share this information in a consistent and standardized way, which can help improve the quality of care and reduce the risk of errors.
To exchange clinical documents via FHIR, the documents are first mapped to FHIR resources. This involves identifying the relevant information in the documents and representing it in the FHIR resources. The FHIR resources are then exchanged between the systems and providers using secure communications protocols, such as HTTPS or TLS.
Additional details on Transforming Clinical Data Exchange via FHIR can be referenced in the article from “Ankit Kumar Agarwal” (dated March 20, 2023).– This article was published at https://distilinfo.com/healthplan/transforming-clinical-data-exchange-via-fhir/.
FHIR is a next-generation standard for exchanging healthcare data electronically. FHIR is designed to be more modern, flexible, and developer-friendly than previous healthcare data exchange standards such as HL7.
The future of FHIR is bright and promising, as it is becoming increasingly adopted by healthcare organizations and technology vendors around the world.
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