FHIR in Action: 3 Real-Life Implementations Taking Healthcare to a New Level

Real-Life FHIR Implementations

HL7’s Fast Healthcare Interoperability Resources (FHIR), an emerging standard for the exchange of health information, has been making an impact in a variety of healthcare settings for years.

FHIR use cases include:

• Sharing medical charts and related documents for insurance claims
• Universal access to a patient’s Personal Health Record (PHR) for enhanced patient management
• Creating comprehensive patient care portals
• Using cloud and artificial intelligence technologies to build predictive solutions and intelligent automation to support aging populations and their care teams.
• The Veterans Administration increased veterans’ mobile health options with FHIR/Apple Health Integration

Let’s look, in closer detail, at three FHIR applications taking healthcare to a new level.

The Gravity Project: FHIR and Social Health Risks

Health risks and outcomes depend on the conditions in the places where people live, learn, work and play. These social determinants have a huge impact on health outcomes—especially for the most vulnerable populations.

The healthcare industry, in an ongoing effort to standardize medical codes and leverage information across care settings, is looking for ways to capture and use social determinants of health (SDOH) data. Standardizing the key data elements necessary for documenting and sharing SDOH-related screening, diagnosis and treatment information means using modern coding and exchange standards.

That’s where FHIR comes in.

Image courtesy of EMI Advisors

Evelyn Gallego, founder of EMI Advisors and program manager of The Gravity Project, says the problem with current medical terminology standards is that they do not have the defined technology standards and resources to effectively capture, use and exchange SDOH data.

In response, The Gravity Project project has assembled a broad range of stakeholders—more than 800 providers, payers, government, health IT vendors and others—to collaboratively develop recommendations for how best to capture data about food, housing and transportation risks and needs.

The Gravity Project is focused on consensus-driven standards for three SDOH domains—food security, housing stability and quality and transportation access. The collaborative is examining use cases to identify common data elements and set guidelines compatible with HL7’s FHIR standard while developing a FHIR implementation guide based on defined use cases and associated data sets.

The Gravity Project has become a part of the HL7 FHIR Accelerator Program, which helps to assist in the creation and adoption of FHIR implementation guides. Other projects within the Accelerator Program include Argonaut, CARIN Alliance and Da Vinci. Gravity implementation guides will reference FHIR profiles developed through Argonaut, as well as other FHIR resources and profiles developed through the Da Vinci Project.

Interoperability and data sharing between healthcare and social care are hampered by the lack of infrastructure, data standards and modern technology architecture shared between organizations.

Gravity aims to solve the problems associated with SDOH data documentation by leveraging FHIR to support the integration of healthcare and social care data, notes Gallego.

“FHIR resources incorporate coded data elements to define the information exchange between two disparate technology systems,” Gallego explains. “The medically coded data elements provide the semantics for the content made available for use within a FHIR resource.”

FHIR, by design, supports structured data exchange. The standard needs to reference unambiguous and well-defined terms so that the information is both human and machine readable. To define and code SDOH data concepts so that they can be represented in FHIR, The Gravity Project is developing a FHIR implementation guide based on the defined use cases related to food insecurity and other SDOH data.

“The Implementation Guide will provide a recipe for how implementers can incorporate standardized SDOH data elements in their technologies and enable the interoperable exchange of data documented as part of screening, diagnosis, goal setting, and interventions activities,” according to Gallego.

“The immediate outcome is the ability for clinical IT systems, such as electronic health record records (EHRs), to incorporate capabilities that support the standardized capture, use, and exchange of SDOH data for care delivery.

“The secondary outcome is the ability for health systems and others users such as health plans, public health, and researchers, to use aggregated SDOH data to inform upstream activities such as population health, quality improvement, risk adjustment, public health and clinical research.”

The public health alignment of Gravity’s mission is front-and-center now, as they are working with Homelessness Management Information Systems to capture structured housing concepts for COVID-19 screening and intervention activities.

If you would like to find out more, click here to learn more about The Gravity Project.

Dermatology Gets SMART at CoxHealth

Image courtesy of CoxHealth

CoxHealth, a Missouri-based health system, had staffing problems. Specifically, they were short on dermatologists, so primary care physicians were increasingly performing dermatology exams.

Naturally, PCPs didn’t have the experience with skin issues needed to make diagnoses and recommend treatments related to skin problems. But a FHIR-powered app is now empowering them make more accurate diagnoses. Using a SMART on FHIR application called VisualDx, thee doctors have access to medical imaging, visualization and machine learning. These allow them to compare known variations of specific diseases affecting the skin, hair and nails and to make a more accurate diagnosis.

The SMART framework supports apps used by clinicians, patients, and others compatible with every health care system. SMART on FHIR API was developed with support from the U.S. government as an open, free and standards-based API. Innovators use it to write an app once and have it run anywhere in the healthcare system.

VisualDx is integrated into CoxHealth’s Cerner EHR. The EHR integration saves physicians time by since the details they need are already integrated into the record. Patient details such as age, gender, medications and existing conditions give the doctor the context he or she needs.

Because it is accessible from their mobile phones, VisualDx connects physicians to patient data in and out of the office, allowing them to create a differential diagnosis, review the possible conditions and learn the details about those conditions.

The Joint Commission: Applying FHIR to Quality Measurement

Image courtesy of The Joint Commission

The Joint Commission is on a mission to improve patient care. The organization is dedicated to developing the standards, tools and resources needed to improve quality assurance, including the things that drive patient safety. In medicine, quality measurement refers to outcomes, patient perceptions of care, efficiency of organizational structure and more—all the data points we measure in our ongoing quest to make improvements to patent safety and other aspects of healthcare.

The Joint Commission is using the FHIR standard to pull and receive pull quality metric data from member organizations (such as surgical outfits) using a specific data format designed to describe medical quality data (The Health Quality Measures Format, or HQMF).

Using IBM Operational Decision Management software, which incorporates IBM’s implementation of Business Event Processing capabilities, The Joint Commission runs the data through a custom-built quality rules engine to analyze existing quality data formats, generate reports and provide rankings to members and government organizations.

The Joint Commission is looking to build upon an early HL7 project where quality metric data (as well as the rules that the data will be measured to) can be specified via FHIR. This requires passing healthcare quality metric data via FHIR as well as being able to write analysis rules in FHIR.

Conclusion

We’ve looked at three very different use cases surrounding FHIR and the innovations the operability standard enables. This is just scratching the surface. To learn about other innovative FHIR implementations, you may refer to HealthIT.gov’s Interoperability Proving Ground (IPG), an open community where for learning about interoperability projects in the United States and around the world.

Are you looking to jumpstart the sharing of EHR data throughout your enterprise using FHIR APIs? As a comprehensive integration and data analysis solution, Quick FHIR lets you move your IBM Operational Decision Management/automation environment into the FHIR ecosystem and pull FHIR quality data from your partners, as well as HL7 Quality rules.

Quick FHIR can help you convert your legacy data quality format for quality rules engine processing. Quick FHIR can take the legacy reports, convert them to the appropriate FHIR format, and store them and/or ship them back to your partners.

With more than 40 years of experience as integration partners and countless success stories in the healthcare industry, Prolifics has the expertise and vision to help your organization take healthcare to a new level with FHIR.