How FHIR® is Driving Change at HIEs

By Justin Kaltenbach

Founder, Outcome Healthcare

March 5, 2022

FHIR® is about Coordinated Care Amongst Stakeholders

To embrace FHIR® entirely is to accept that Health Information Exchange is about having a patient-centric approach that consistently meets the needs of those in care and those delivering their care. So, how does FHIR® help patients? Providing accessibility and the free flow of information is a lasting benefit from the 21st Century Cures Act.

Allowing the medical records across various systems of all patients to be accessed by distributed but secure users to include physicians, payers, and patients ensures communication. FHIR® is the means to enable easy access to healthcare data and seamless communication between various stakeholders.

Outcome Healthcare has worked with organizations passionate about delivering superior care to patient populations for more than 15 years. In response to the growing demand for interoperability, intuitive workflows, and better user experience, we deliver a healthcare architecture that enables HIEs to manage patient data securely, accurately, and quickly. Outcome Healthcare developed the HIE architecture processes to maintain a healthy ecosystem of quality patient data that can be provided by and requested from participants at any time and with full traceability.

Figure 1. Outcome Healthcare HIE Architecture Example

FHIR® Makes Data Sharing Easy for Stakeholders

With the implementation of FHIR®, every piece of data is linked with a unique identifier. FHIR® takes the work from getting access to the correct data set from any device or application. By assigning standardization for different data resources, FHIR® eliminates and cuts down extended processes of exchanging data back and forth between systems.

This feature is of particular interest to organizations searching for new solutions to sunsetting products. When receiving data via an HL7 message or a CDA, the participant is given an endpoint and port for a channel in Mirth Connect to send a specific type of message. These messages are received, and the data is analyzed. If the information is found to meet the standards set and is not filtered, the message is transformed to improve the quality of the data further before it is ingested. These improvements can include but are not limited to value mappings, removal of sensitive data, and filtering of imperfect or incomplete data. Additional data such as patient group, consent, provider-to-patient relationships, or other qualifying features are written to a transactional database. Once the message has been transformed, it will be sent to FHIR® Clinical Data Repository (CDR) for ingestion. Every transaction successfully ingested by FHIR® CDR is logged in a Postgres database table; if a transaction causes an error, then that error is logged in a similar but distinct database table. Through developing these tools, Outcome Healthcare can ensure that every message received from any given participant will be carefully processed and ingested with a paper trail attached.

FHIR® Specifications Are Free to Use with No Restrictions

A significant benefit beyond why FHIR® is better for sharing health information is that specifications such as these are free to use without any restrictions. With documentation improved under FHIR®, quality has gone up for outcomes.

For example, if a patient has already been created previously, a new message successfully ingested will add all available data from the given data source to that patient’s profile in the Outcome Healthcare Clinical Portal, using the FHIR® standards. This action allows providers to gain additional insight into their patient population and histories. Meanwhile, if an HL7 ADT message is received for a patient with no previous record, a new patient is created in the Outcome HIE Platform and populated with any data that the ADT contains. The Outcome HIE Platform also leverages the Postgres database for consent, patient groups, and other vital indicators necessary to health and business operations. If a CDA is received for a patient, in addition to the data being ingested, the document is also connected to that patient electronically and stored accordingly in the Document Registry / Repository.

FHIR® Is Ready for a Mobile World

Caregivers are now mobile users, too, and the advent of telehealth is increasing tremendously over desktop users. FHIR® is a platform that can be deployed and accessed by mobile devices and is ready for today’s challenges of BYOD. Most mobile devices support programs with HTTP and JSON. And the invention of more healthcare-related applications and telemedicine software has followed suit. FHIR® has a strong foundation in web standards, including XML, JSON, HTTP, Atom, OAuth, etc.

For the HIE, when a participant initiates a Document Query for a given patient, the FHIR® CDR is accessed. If the patient exists in the system, the FHIR® JSON object is returned, which contains all the patient’s historical documents. Any documents from the participant that is querying are filtered out to avoid providing duplicate data. A summary document of all the patient’s historical data is also generated and made available. After returning the existing documents, a Document Retrieval message will follow from the participant requesting a specific document. The document in question is then retrieved from the Document Store, securely encoded, and sent back to the participant.

Each patient history is stored in the CDR via an FHIR® JSON object that contains all their data. Whenever a new message is received for a patient, a call is made to the CDR to retrieve their patient record. The patient record is updated with the latest data and displayed in the Outcome Healthcare Clinical Portal.

FHIR® Supports RESTful Architecture:

FHIR® supports RESTful architecture and delivers seamless information exchange using messages or documents. With the help of FHIR®’s built-in REST API, you can manipulate healthcare data easier than ever. You can use functions like POST, DELETE, GET, and PUT to create, read, or otherwise manage resources.

For example, a developer can use “PUT” to update a resource when the data changes or needs to get changed. The FHIR® tools save enormous time by making online data sharing easier, which was the design of the project.

The patient data in the CDR is backed up on a Data Warehouse. This Data Warehouse is accessed to generate reports on what type of data is ingested, the volume of data consumed, what participants are sending data, and other valuable content. These reports can be used internally or sent to data-consuming participants. Furthermore, the Data Warehouse facilitates bulk data extracts by data consumers—helping prevent potential strain from being placed onto the CDR.

FHIR® Implementations are Faster and Easier than Past

History has not proven a good case study for rapid implementation in the healthcare industry for delivering effective patient care via new technologies. But FHIR® serves as the best standard for making healthcare information exchange easier, and it proves to save time and information sharing. Architected to integrate with your partners, FHIR® is shown to drive time savings and improve communications. The easy-to-use interface of FHIR® is a great advantage for the users, and this will help improve the experience of the healthcare worker.

FHIR® enables more accessible, faster, and significantly more flexible development of interfaces that scale well. While developers enjoy the ease of working, for FHIR to achieve healthcare interoperability in the long term, it needs to be implemented correctly.

Outcome Healthcare is proud to work with some of the country’s most forward-thinking HIEs, and we have been at the forefront of developing an architecture that can be hosted by either the client’s IT staff or fully supported by our team of experts.

FHIR® Means Cost-Effective Solutions

Healthcare reform requires information sharing and cost controls, and FHIR® is quite adaptive and easy to use compared to other complex standards. With FHIR®, health data can be shared seamlessly tracked, and the results can more cost-efficiently provide predictive and prescriptive outcomes analysis.

Trusted. Simple. Highly Performant. Outcome Healthcare provides trusted HIE technology that enables the secure transfer of health information, is easy to install, and easy to deploy and manage to deliver up to 50% faster processing times than previous solutions.

Talk to Outcome Healthcare today about your Health Information Exchange conversion to FHIR® and how to ensure the most significant value from your IT time and resource investments. [email protected]

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