practical insights into real-world fhir implementation
TRANSCRIPT
Practical Insights into Real-World FHIR Implementation
October 14th, 2021
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Agenda
Introduction Lessons Learned
FHIR API Implementations
Market Landscape& Regulation
Things to Consider
Strategic Vision
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Presenters
Teresa YounkinPoint-of-Care Partners
Senior Consultant
Vanessa CandeloraPoint-of-Care Partners
Senior Consultant
Brian DwyerPoint-of-Care Partners
Growth Lead
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Who is Point-of-Care Partners?We Are THE Nation’s Leading Data Standards and Interoperability Consultants
What We Do…
• National, virtual, consultancy since 2002 (35+ states, 110+ Associates) focusing on healthcare Interoperability across the Payer, Delivery, Health IT Vendor, HIE, Government, and Pharma ecosystem
• We possess a comprehensive staff of widely respected national experts, with most Associates having > 15-20 years experience in the Interoperability field
• Engaged with Standards bodies and Accelerators across the Interoperability spectrum, including HL7, HIMSS, Da Vinci, CARIN, NCPDP, and numerous others
• Leading subject experts who have been involved in or run projects such as:
‒ The launch and growth of numerous HIEs‒ Strategy and Development of ePrescribing standards
and functionality‒ Deep engagement with ePA vendors for standards,
strategy, and functionality‒ Strategy and value engagement for national and
regional payers• Program Managers for the Da Vinci HL7 FHIR
Accelerator Program, the Nation’s leading and largest FHIR-centric multi-stakeholder collaborative
• Deeply engaged in CARIN, CodeX, ONC FAST
Who We Are…
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What We Do: POCP Works Across Stakeholders To Deliver
• Market Intelligence
• Strategic Planning
• Value Modeling
• Program Design and Management
• Standards Development
• Health IT Implementation
• Product Strategy and Design
• Regulatory and Legislative Analysis
• Research and Evaluation
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POCP Leadership and Participation in HL7/FHIR Initiatives
Payers/Providers
Consumers
Cancer Careand Research
POCP is the Program Management Office and works daily with Da Vinci Members including Payers, Providers, technology vendors, and industry organizations to solve problems for interoperability in support of value-based care.
POCP team members are driving the development, publishing, and subject matter expertise on CARIN’s Real Time Benefit Check use case and FHIR Implementation guide, working between HL7 and the NCPDP. POCP is leading the effort, acting as lead with standards processes and coordinating the vendor, EHR, provider and payer communities to get the right information available in a standard way.
POCP is the lead advisor to the CodeX Program Management Office providing guidance ranging from Governance and Member Recruitment to day-to-day use case level management and strategy.
Scalability
POCP provides program support to ONC/FAST leadership and industry-led FAST Tiger Teams to develop, document, and present the infrastructure scaling challenges and recommended solutions to the industry, and coordinates with HL7 as the Tiger Teams bring their solutions through the standards development process.
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Market Landscape & RegulationHISTORY
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Interoperability Drivers
Shift to Value-Based Care• Focus on outcomes
• Innovation in business models and use of technology
• Shared Upside/Downside between payers/providers
Regulatory Requirements• Data Blocking• Coverage Portability• Price Transparency• Ensure privacy and security
Quality and Safety• Improve information and
attestation in workflow• Follow agreed upon best practices• Unlock payer data to care givers
Consumer Demand• Ease of Access• Clear understanding of benefit
and coverage• Ability to see cost/quality data• Patients manage own data• Ensure privacy and security
Interoperability
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20 Years of Information Technology Advancement in Healthcare
Patient Protection and Affordable Care Act &
21st Century Cures Act
MIPAA and MACRA
HITECH Act of 2009
Administrative Simplification Act of 2001
2001 2009 5/2020 1/1/2021 1/1/2022 1/1/2023
Electronic Claims
Electronic Prescribing
Data Blocking
Patient Access
Payer to Payer Data Exchange
USCDI
Price Transparency
Electronic Health
Records
ADT Notifications Prior Auth
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Interoperability Rules Reference Links
More information can be found here:
Interoperability Rules: ONC Cures Act Leads the Transformation21st Century Cures Act Key ComponentsInteroperability Rules: CMS Patient Access Builds on StandardsCMS Interoperability and Patient Access final rule (CMS-9115-F)Interoperability Rules: CMS Reducing BurdenReducing Provider and Patient Burden and Promoting Patients' Electronic Access to Health Information proposed rule (CMS-9123-P)
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Key Takeaway:You can leverage your relationships, federal regulations, and amped up industry activity to take action now.
Market Pressures
Lack CMS/ONC Interop Rules Awareness has turned a strategic opportunity into a FHIR drill.
Organizations have strong provider relationships, but lots of broken processes when it comes to data exchange (Prior Auth, Quality Reporting, Risk Adjustment).
Participating in Value Based Care arrangements is recognized as “doing good business” but the burden of workflows to support these efforts for both payer and provider slow down progress.
2021-2023
Everitt Rogers’ Diffusion of Innovation Curve
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FHIR API ImplementationsVoice of the Market Summary
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Voice of the Market: Sampling of Various Stakeholders Input
Healthplans Healthcare Technology Vendors
Integrated Delivery Networks
Providers
Hospitals
Standards Development Organizations
“The hard part is not the standard or the regulation. The hard part is figuring out what data you have, where it lives, and how to get it out to use it” – Executive Advisor, Healthcare IT Vendor
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Voice of the Market: High Level Theme
Data initiatives are multi-faceted and complex, and every organization struggles with the same issues
Strategic Vision & Action
Market PressuresRegulations
Data StandardsDefining Value
“PEDMAS”
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Voice of Market Executive Summary
Interoperability is not new but strategic roadmaps need to re-define business process and separate resources for execution
Participation in Standards Development Organizations (SDOs) and Multi-Stakeholder collaboratives at the right level provided competitive advantage and eased ability to stay ahead of mandates.
Lessons Learned emphasized applying the right standards to the right problems and that it’s not just a technology project.
Adoption at the speed of trust
Future Outlook of Healthcare shows FHIR APIs and third-party apps to put patients at the center of their data and care.
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Current State of FHIR ImplementationsVoice of the Market
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Voice of Market: How Did Leaders Get Started With FHIR APIs?
• Interoperability is not new
• Innovation leads to breaking down the walls with APIs
• What brick to pull out and free the data depends on an organization’s goals, objectives, and culture
Regulatory Compliance Value Based Contracts
MembersQuality Measures
Care Coordination Product Improvement
Burden Reduction
Risk Adjustment
Interoperability with Payers and Providers is not new. Most organizations (that need to be) are adding FHIR to their technology journeys.
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Transformation: Shift Towards API IntegrationInteroperability Yesterday
• Share information with our providers and members in many different, but largely inefficient and proprietary ways• Connections are hard walls, data within organizations is in silos with sometimes 50-100 different vendors
CUSTOM INTEGRATION
EXCEL FILES
FAXES
MANUALLY FOCUSED
PROVIDER 1
PROVIDER 2
PROVIDER 3
PROVIDER 4
PAYER 1
PAYER 2
PAYER 3
PAYER 4
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Transformation: Shift Towards API Integration
Emerging Standards
Agreed Upon Ways to Use
Standard
Shift to Real Time
Information from Batch
Process
Improved Tools to Build Applications
INTEGRATORS INTEGRATORS
PROVIDER 1
PROVIDER 2
PROVIDER 3
PROVIDER 4
PAYER 1
PAYER 2
PAYER 3
PAYER 4
“Document based exchange” to “controlled Access.”
– Leader in HITStrategy & Policy
Interoperability Tomorrow is API Enabled
• Build reusable, scalable services across multiple partners• Keep customization to configuration or at edges, focus on content,
workflow and services, not transport
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Standards Driving Next Wave of Innovation• Rise of APIs
– FHIR built for purpose – ONC FAST – Focused Implementation Guide and Tooling
• Now 5 Accelerators and more collaborations appearing monthly– SDOH– VBC– Consumers– Cancer Burden Reduction– Pharma Research
• Convergence of clinical and administrative data– USCDI– TEFCA & QHINs– Tradition players shifting
WEDI/CAQH/X12/NCPDP evolution and role in API community
– ICAD Taskforce Organizations with focus, maturity or growing competencies are now poised to come through transformation faster and more nimble
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Lessons Learned and Things to ConsiderVoice of the Market
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Conflicting and Nebulous Regulations and
Standards
Multiple and Complex Process due to the use of
Different EHRs
Payer API Challenges
Different Rules/Logic for each Payer
relationship
Key Takeaway:Any API payer solution should work for all-EHRsfrom the providers perspective and must meet providers where they are today to get adoption.
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API Adoption: Provider Challenges
Limited ROI for providers: “What’s in it for me?”– Unless a provider is “at risk” or is participating in quality improvement program
there is little incentive for the provider to ensure they are using data standards
Availability of clinical documentation and quality documentation in workflow needs to be consistent across the board to improve adoption– The more Payers offer assistance in helping to standardize the data the
greater provider adoption
Champion is key for adoption– Finding a champion inside the practice is key to education and adoption
Key Takeaway:Provider adoption is key to a successful quality initiative, but unfortunately, there is no incentive for providers to use data standards. The key is making the data capture workflow easy enough for them to want to use it.
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Lessons Learned: This is Not Just a Technology Project…It’s Solving a Business Problem Then Applying an API to Help Solve It
PHR Identify the incremental value of adding additional APIs.
Treat implementing data standards like a business problem with a business solution and use IT help solve the problem.
“All this clinical data is unstructured and non-standardized so using FHIR is forcing them to standardize it.”
– CTO, National Health Plan
Create your Coalition of the Willing to understand data needs.
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Data Governance
ProviderService
LegalRegulatory
SecurityPrivacy
AnalyticsBI
UtilizationManagement
ProviderContracting
RiskAdjustment
IS/IT
CareManagement
Customer Service
AccountEmployers
-CTO, National Health Plan
"We will wait to see how the market is moving and keep moving even if there are regulation(sic) delays.“
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Align Benefits and Measures of Success to Business Processes
Improved Consumer ExperienceLower Cost of Care
Increased Care Coordination
Greater Consumer Engagement and Shared Decision Making
Better Patient Outcomes
Improved Quality and Safety
Greater Operational Efficiencies/Reduced Burden
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Apply the Right Standards to the Right ProblemsWhile FHIR is a worthy standard – It's the work of leaders to understand the workflow to answer the following questions and translate the value of APIs to organizations
Who should we be focused on?
What do weneed to know?
When dowe need to weneed to act?
How willwe pay for this?
Why does this matter to our
organization?
Where dowe need to automate
a workflow?
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Business Transformation
“Now that you have all the data –what’s the next step? What is the strategy? It was a lot of work to get all the data.”
– Leader, Claims Health IT Vendor
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Strategic VisionVoice of the Market
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When the Data Flows…
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/ Hea
N
The Future: Pervasive Stakeholder Impact of API Technology
Data Blocking
Payers
Health Systems/ Providers
EHR/HealthIT Vendors
Patient / Caregiver
Data SharingCertification
Provider DirectoryPayer-Payer Info Transfer
Data Sharing
Financial Penalties
Patient SafetyADT Notification
Daily updates
Data Sharing Single/BulkData Blocking
Data Sharing Single/Bulk
Mobile Apps Consumer ChoicePatient Empowerment
Patient Access
Patient Access
Patient Access
Improved Quality of Care
The transition to the future state is a multi-year series of incremental and increasing complex steps…
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Executive Summary Recap
Future Vision:• As standards are adopted strategic opportunities become clearer for those who are ready• Standards are being adopted as a business initiative, not a technology initiative• How it’s being looked at for strategic gain/operationalizing (incorporate into workflow)
Reality of the readiness of the market• APIs should fit into the provider’s workflow • If we build it, they will come, BUT adoption is at the speed of trust.• Understanding value is more than ROI for these projects• Aligning the regulations with strategic initiatives is a must
Market Landscape• History• Regulation driving API • Market Pressures
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Next Steps for Success
Assessment of where you organization is on their API journey– Organization Change– Technology Adoption– Data Mastery
Understand organizational strengths and weaknesses– Not master of all that is happening– Identify where you can and should lead– Know what rocks to unbury, surface
challenges and own them sooner vs later
Monitor Outside Impacts, and understand where and how to be engaged outside your own organization– SDOs– Accelerators– Regulatory Process– Vendor Strategy and Needs– Industry groups and professional
organizations– Government and industry advisory
roles
Successful Interoperability Strategy understands where change is occurring, challenges and opportunities specific to the organization, both current state and driving incrementally toward future.
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