What the FHIR Mandate Means For Your Business

| Author , tagged in healthcare data interoperability, fhir
Cloudticity, L.L.C.

Interoperability has gone from a best practice to a mandate. Last year, the U.S. Centers for Medicare and Medicaid Services finalized a requirement for the use of Fast Healthcare Interoperability Resources (FHIR) among many CMS-regulated payers and providers by July 1, 2021. Put simply, if your company serves patients on Medicare or Medicaid, you need a plan to adopt FHIR’s interoperability standard across your organization.

This new interoperability requirement will change healthcare for the better by improving access to information and interoperability across healthcare systems. However, a change this massive can also inspire many questions about what the FHIR mandate means for you. In this post, we’ll look at frequently asked questions about the 2021 FHIR mandate and the ONC Final Rule to help your organization meet compliance with minimal disruption.

Why is FHIR required and what does this mean for me?

The not-for-profit Health Level Seven International (HL7) created the FHIR standard in 2011 to simplify how healthcare providers, payers, and patients shared healthcare information. In the past, electronic medical records (EMRs) and other healthcare data were often stored in all kinds of proprietary systems. This meant healthcare organizations had to rely on a patchwork of inefficient processes to access and share healthcare information across systems—slowing down decision making, increasing costs, and worsening outcomes for patients. To address this problem, HL7 created FHIR—an open, developer-friendly standard designed for greater interoperability across healthcare systems and devices.

Now the CMS Interoperability and Patient Access final rule has introduced technical standards that require most public payer entities and healthcare organizations to adopt FHIR. Practically, this means your organization faces new mandates aimed to simplify access and sharing of healthcare information, including (but not limited to):

  • CMS-regulated payers now must implement and maintain a secure Patient Access API allowing patients to easily view information about claims using third-party apps.
  • Many healthcare plans and providers must make provider directory information publicly available in a Provider Directory API.
  • CMS-regulated payers must share patient clinical data with other payers whenever patients request it.

Failure to follow the new FHIR mandates from the ONC final rule can lead to regulatory fines and other compliance issues. You need a plan to adopt and enforce the FHIR standard across your operations.

What are the key challenges of FHIR adoption?

Understanding the FHIR standard, building or finding a service to comply with it, and empowering your IT team to manage this solution is no small task. Here are three of the most common challenges in adopting FHIR:

  1. Cost

    Because FHIR is a relatively new standard, there are few commercial solutions on the market—and these commercial options can be expensive and require extensive customization to integrate them with your existing EHR system. There are open-source FHIR solutions available such as FHIR Works on AWS and HAPI-FHIR. While open-source solutions are more cost-effective, they still require both expert knowledge and significant time to implement. 
  3. Complexity

    As a standard that applies to all healthcare data, FHIR will affect many aspects of your operations. Whether you choose a commercial option or build an in-house FHIR implementation, you’ll need skilled developers able to tackle the complexity of FHIR. For example, FHIR has 145 defined resource types, all in varying levels of maturity within this still evolving standard. Your developers will need to learn the details of the FHIR specification while evaluating and modifying open-source and commercial options for FHIR implementation.
  5. Management

    Once your FHIR implementation is complete, your IT team will need training and resources to manage and scale your FHIR service over time. This could involve adding new infrastructure, updating security, and learning new technical skills as the FHIR standard continues to evolve.

How can I get ready for FHIR?

To comply with new FHIR-related policies, many organizations have found a cloud-based strategy to be the most economical and efficient solution. A FHIR cloud implementation can help you accelerate provisioning, simplify customization of your environment, and make it much easier to scale capacity to fit your needs—not to mention control resource costs. 

However, a successful cloud-based FHIR implementation doesn’t happen by default. Because of the inherent complexity of FHIR compliance, organizations should work with an expert partner who has significant experience launching and managing healthcare solutions in the cloud. Just as nearly 80% of healthcare organizations have hired data architects to define their interoperability strategies, the success of your FHIR implementation may depend on the cloud partner you choose.

To learn more about the coming FHIR deadline and how your organization can prepare using cloud-native, open-source tools, read this white paper.

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