A few decades ago, healthcare lagged well behind banking, retail and other industries when it came to digital transformation. Passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2010 put healthcare providers on the path for adoption and meaningful use of health IT.  According to the Office of the National Coordinator for Health Information Technology (ONC), only 9% of non-federal acute care hospitals and 17% of office-based physicians had adopted EHRs in 2008. By 2021, those numbers hit 96% and 78% respectively. 

The journey has not been easy. When healthcare providers began making the switch from paper to electronic records, different systems didn’t “talk” well with each other. Interoperability (or the lack of it) dominated the agenda. Today, interoperability remains a trending topic in healthcare. New regulations are coming into force. New technologies are being developed. And a big piece of the solving the interoperability puzzle is HL7Ⓡ FHIRⓇ, AKA Health Level Seven International’s  Fast Healthcare Interoperability Resource standard. Take a closer look at what it involves and how it impacts prior authorization software. 

What is HL7 FHIR?

1. FHIR emerged to solve communication problems rampant when EHR adoption began in earnest.

In the wake of interoperability challenges, HL7 introduced FHIR in 2014.  It establishes a standard for data formats and elements and an application programming interface (API) for exchanging electronic health records (EHRs).  The  experiment to support app development and enable fast, secure data exchange between healthcare record systems quickly earned buy-in across the industry, with major players collaborating on the Argonaut Project. This private sector project fast-tracked development of a FHIR-based API and Core Data Specification and has since continued to work on different components to address specific needs like secure web messaging, clinical data subscriptions and more. Sponsors include organizations across the healthcare spectrum including Accenture, Apple, Cerner, Epic, HL7, Humana, Intermountain Healthcare, Mayo Clinic, Microsoft and others. 

2. FHIR trials have been successful enough that it will soon earn full standard status.

In 2017, FHIR became a full standard, still limited to trial use. In the meantime, it has been part of other major endeavors: 

• SMART on FHIR: Undertaken by Boston Children’s Hospital, this project created a set of open specifications to integrate apps with EHRs, Health Information Exchanges (HIEs) and other health IT systems. 
• HAPI FHIR: University Health Network in Ontario, Canada  built out a library for adding FHIR messaging to applications. HAPI FHIR is a free, open source resource for anyone to use. 

3. FHIR specifications bring consistency to healthcare app development. 

The core components of FHIR include: 

• Ready-made RESTful APIs shorten development timelines thanks to “plug-and-play” integration.
• FHIR Resources are exchangeable content, standardized to enable data exchange between different EHRs. 
• FHIR Profiles is a set of rules that enables a FHIR resource to include extensions
• Attributes refer to resource-specific metadata. This data allows disparate systems to interpret the data framework in a consistent manner. 
• Resource Data Formats define the elements FHIR resources must include to allow for accurate data exchange and storage.

4. FHIR resources use the most common file and data interchange formats.

FHIR uses a modern web-based suite of API technology, including an HTTP-based RESTful protocol and data representation via JSON, XML, or RDF. The idea is to make interoperability easier between legacy systems and more contemporary apps across a range of devices. 

How Do Providers, Patients, Payers and Health IT Vendors Benefit from FHIR? 

5. FHIR makes data easier to exchange and interpret.

Across healthcare, stakeholders still rely on paper documents, often faxed, emailed or transmitted electronically. It’s like working with PDFs. The “document” may be digital, but the information is still less accessible because it isn’t in a format that can be easily exchanged. Plus, someone has to read the document to find the pertinent information and move it where it needs to go. FHIR APIs can feed the relevant data directly into an EHR or other system of record. 

6. FHIR helps avoid provider miscommunications common to document-based exchanges.

For example, prior authorization software can be integrated within an EHR with seamless data exchange. Not only does this shorten the turnaround time for identifying prior authorization requirements and submitting a request, but it removes the need for repetitive data entry which can result in preventable errors that lead to delays and denials. 

7. FHIR enables digital experiences that consumers favor in other industries.

FHIR unleashes the potential for using wearable technologies to improve patient engagement, enable wellness monitoring and more. Patient-generated health data (PGHD) is growing at an incredible rate, and it could prove very useful in individuals’ health and wellness journeys if providers can access it easily. Dr. Nick van Terheyden, Chief Medical Officer at Dell told Health IT Analytics that “Physicians want data, but they want it presented in a way that is useful and actionable for them. I think integrating that information into the existing workflow in a secure manner is really the goal. That’s where we will start to see real value.”

8. FHIR uses cases fit multiple scenarios. 

Many stakeholders across healthcare have engaged in FHIR development projects. Examples include: 

• Specialty specific applications to break down data silos and inform population health management programs
• Clinical decision support in near real-time for point-of-care providers
• EHR-agnostic applications and integrations, such as automated prior authorization

The ONC has extended several FHIR-based app challenges featuring hundreds of thousands of dollars in prize money and other industry organizations like The CommonWell Alliance, Carequality, and the Sequoia Project are exploring FHIR’s potential as well. 

9. FHIR has the potential to transform the healthcare landscape and move us closer to value-based care.  

It benefits patients because now their health records are consolidated, integrating data from different sources and formats to provide a 360-degree view of their healthcare experience. When combined with other health IT like health and wellness apps, it encourages patients to take a more proactive role in their own health. As we all know, patient engagement will be even more critical as more providers make the shift to value-based care. 

It benefits providers by delivering data to a central location, enabling  improved care coordination and delivery. And because it facilitates seamless data exchange, it reduces administrative burdens associated with the current, paper-based status quo. Bonus: Freeing office and clinical staff from time-consuming, error-prone manual data entry and administration also leads to more job satisfaction, a critical advantage when staffing shortages continue to plague healthcare. 

It benefits payers, facilitating improved data exchange and visibility into members’ healthcare experiences to enable proactive support for members which can improve both satisfaction and retention. 

It benefits healthcare researchers, allowing use of de-identified information for developing  precision medicine, analyzing population health trends, and more.   

How Does Prior Authorization Software Use FHIR? 

Prior authorization software leverages FHIR APIs for data exchange, but that’s not all it does. It uses intelligent automation and what we call Collective Healthcare Intelligence™—a single source of truth for patients’ health and benefits information, providers’ clinical documentation, and payers’ plans and policies. 

The data exchanges happen seamlessly, reducing manual data entry by 70% or more. That’s because transactions can be run simultaneously. Not only does this speed up the process, but it also reduces opportunities for preventable denials up to 90%.  First, there are fewer chances of a typo being introduced during data entry. Second, the data push-pull enabled by FHIR, combined with an extensive payer policy library and rules engine, helps ensure that prior authorization submissions meet the requisite criteria. 

Seeing is believing. Arrange a demo of Myndshft prior authorization software to see how FHIR could accelerate your workflow.