February 6, 2023
by Erin Leighton, RHIA
Healthcare’s technological frontier is readying itself for what some are calling the most significant leap forward since the release of the 2009 Meaningful Use Final Rule. Famous for its impact on EHR implementation, Meaningful Use propelled healthcare into the 21st century by incentivizing use of certified electronic health record technology (CEHRT). Nearly a decade later the 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program was signed into law, packed with new requirements for certified health IT developers and revisions to the 2015 Edition Certification Criteria. In a nutshell, the Cures Act is designed to put technology at the forefront of information access for patients and providers. Meaningful Use was successful in moving electronic health record adoption forward, but the Cures Act wants those systems to exchange data seamlessly.
While it can feel overwhelming to unpack the nuanced requirements of the Cures Act, much of the heavy lifting will fall to certified health IT developers and EHR vendors. One example is the provision of a standardized API (application programming interface) for patient and population services, using the Health Level Seven (HL7) FHIR standard.
Published and maintained by HL7, FHIR (pronounced fire) stands for Fast Healthcare Interoperability Resources and is designed to integrate claims with clinical data via the use of common language. FHIR is a standard for exchanging health information in electronic format with the goal of eliminating the abundance of data silos that plague today’s healthcare delivery system. Simply stated, FHIR aims to put everyone – providers, payers, and patients – on the same interoperable playing field, securely, while exponentially increasing scalability.
FHIR draws upon previous HL7 solutions like Version 2 (V2) and Clinical Document Architecture (CDA) but is a superior standard since it supports a wider range of data formats and is designed to deliver faster exchange of data. An added benefit is that most software developers and IT staff are already familiar with it, significantly reducing the learning curve of implementation.
Though gaining ground in recent months, FHIR has existed for years, first proposed in 2011 by HL7 and widely used in the banking industry (think smartphone banking apps). In 2021, HL7 Da Vinci Project, a private sector FHIR accelerator comprised of payers, health IT companies, and healthcare entities, received a HIPAA exception from the Centers for Medicare & Medicaid Services so that FHIR could be real-world tested for use in prior-authorization queries (end-to-end connection between a health system’s EHR and one or more payers).
Other Da Vinci use cases include:
The Centers for Medicare & Medicaid Services’ Digital Quality Measurement Strategic Roadmap (dQM Strategic Roadmap), published in March of 2022, outlines a four-pronged approach to transforming our quality measurement landscape by (potentially) 2025 via FHIR-based measure calculation tools (MCTs).
A notable local use case of the FHIR-based standard includes health information exchanges (HIEs) and health information networks (HINs), like Maine’s HIE, HealthInfoNet, who announced last year that it is developing a FHIR-based API framework for healthcare partners to connect to, with the hope of broadening and optimizing statewide interoperability.
As of December 31, 2022, all certified health IT vendors were required to have FHIR-enabled versions of their products. EHR giant, Epic, made this technology available to customers with its August 2021 update; other early adopters include Cerner and Athena. On the 2024 horizon, Federally Qualified Health Centers (FQHCs) will be impacted by the Uniform Data System (UDS) Modernization Initiative that requires certain tables to be reported at the patient-level via FHIR-based API for the 2023 performance year.
While Community Care Partnership of Maine doesn’t have its own electronic health record, we’re very much preparing for a future on FHIR. What follows is a comprehensive list of steps we’ve already taken to stay informed and engaged, as well as key tips for preparing to implement FHIR at your organization.
How is Community Care Partnership of Maine preparing for FHIR?
How can hospitals and health centers prepare for FHIR?
Additional Resources
2015 Edition Cures Update Fact Sheet
2015 Edition Cures Update Quick Reference
ONC Compliance Dates & Timeframes
HL7 FHIR Case Study: Improving Patient Safety & Care while Reducing Claims Denials
HL7 FHIR Case Study: Digital Infrastructure for Community Hospitals
HL7 FHIR Case Study: Reducing Hospital Readmission Rates & High-Cost Care
Erin Leighton is a Registered Health Information Administrator (RHIA) certified by the American Health Information Management Association (AHIMA). She is the Data Analytics & Information Systems Manager for Community Care Partnership of Maine, a Maine-based Medicare Shared Savings Program Accountable Care Organization (ACO) and serves as the 2022-2023 Legislative Committee Chair for the Maine Health Information Management Association.