By Florian Quarré, Chief Digital Officer for Ciox

In Healthcare, gaining a comprehensive view of a patient’s health is famously hard to achieve. For the most part, the complexity lies in the data: record silos, variability from one health system to another, variability in coding standards, technical constraints, countless devices and operating systems, paper records … It all amounts to a massive challenge in sourcing and acquiring medical data and making it usable across the Health IT space. These challenges significantly impact the ability to serve patients through their continuum of care, to integrate their care journey with their various care providers. For Government stakeholders, these challenges can slow down the ability to efficiently and expeditiously identify sentinel events for the CDC, or make the submission of Medical Documentation to CMS far costlier.


HL7’s Fast Health Interoperability Resource (FHIR) is one advancement that should help solve interoperability concerns for the future. Now in its fourth release, FHIR is a format and exchange standard for accessing electronic health records. It builds upon previous data format standards from HL7, and is easier to implement as it uses a modern web-based suite of technologies, including RESTful APIs and structured content in JSON. It also uses a futureproof standard definition that ensures both information suppliers and information consumers can continue their accelerated adoption without fearing costly changes through future versions. In short, FHIR speaks the language of the modern digital world in a divided Healthcare ecosystem.

From automated and interconnected care plans to intelligent software agents and automated clinical intervention, FHIR is built to connect systems. It saves time and improves accuracy. The recently released FHIR 4 also promotes increased security, ensuring that a patient’s care network, doctors and approved family members are appropriately authorized to share records. FHIR will achieve a number of goals including the improvement of mobile access to health record data, expanded capabilities for Blue Button types of implementations for patient access, enhanced privacy and security compliance and more.

All of this means more fluid data exchanges, and ultimately better decisions to financially or operationally support patients, citizens and plan members. For Government providers like the VA and other agencies, where the goal is to streamline clinical decision making, FHIR allows for better understanding patients and their backgrounds, families and their genetics, historical treatment patterns and other systematic pieces of information that can drive care delivery and improved clinical outcomes.

FHIR Needs Adoption

Yet, FHIR cannot be the final answer if it is not widely adopted. While HL7/FHIR is accepted standard in other parts of the world, it is not mandated in the U.S. New rules from HHS have recently been proposed that would change this; the proposed rule would “support seamless and secure access, exchange and use of electronic health information.” In essence, the ONC would hold Health IT developers accountable to interoperable standards as a condition of certification. But those rules are not yet laws, which means the industry can still operate with incomplete health information delivery and missed opportunities to serve patients better.

There is a collective effort underway to solve interoperability and better serve patients, and FHIR is one of the answers. Some health data companies are pivoting their model to address interoperability and deliver FHIR-ready data from otherwise paper records. Through the technological implementation of clinical decision support (CDS) hooks available to FHIR-based applications, and by using existing (and pervasive) health information retrieval networks to gather patient data at scale, today it is possible to programmatically retrieve and deliver FHIR-ready data, regardless of whether the data was ever FHIR-enabled or not.

The Way Forward

This is a new way to think about data. For companies that are currently grounded in the legacy approach for managing the release of information and supporting medical records exchange, today it is all about standardized and controlled open-data. With new data platforms and the ability to share information across vendors, Healthcare institutions can retrieve clinical documentation from the ecosystem in a standard way. This standardization allows for more rapid implementation of new data sharing capabilities.

Currently, the number of providers who effectively make data available through FHIR is limited, but growing. As more sources of information come online and as they share through interoperable formats like HL7/FHIR, we can begin bridging critical information gaps.

Take, for example, waste in Medicare. Each year, Medicare makes billions of dollars in improper payments. CMS employs a variety of review contractors to measure, prevent, identify, and correct these improper payments. But much of the work is still paper driven, even though the Electronic Submission of Medical Documentation (esMD) system has been live since 2011. For official submitters of esMD to CMS, the ability to acquire health information in a digital format, and to transmit that data to other agencies efficiently, would allow the Government to aggressively participate in redirecting taxpayer dollars spent (and wasted on improper payments and other loss items) towards more profound insights and better patient care.

While the systems are not perfect, advances are at the next technological horizon, and FHIR continues to take us closer to a more efficient era in health data and, ultimately, better health outcomes.

Florian Quarré, Chief Digital Officer for Ciox Health is a technology executive in the health information technology space with over 15 years of expertise leading and advising the transformation of large Healthcare organizations within the US and globally, using emerging technologies – such as blockchain and AI – with an accelerated incubation path to swiftly deliver enterprise business value. Prior to his role at Ciox, Florian led Deloitte Consulting’s Healthcare blockchain practice, focusing on the adoption of blockchain as both an enabling as well as disrupting technology, challenging the status quo on the realm of possibilities for the industry. Florian holds a dual Masters in Computer Science and Information Systems Management from both France and the US.

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