Jan 19 2023

Federal Officials Urge Healthcare Industry’s Adoption of FHIR for Interoperability

The Department of Defense, among others, is already using the data standard to streamline health information exchange, expedite scientific discoveries and ensure health equity.

The best way to ensure electronic health record systems can share data interoperably is for industry to adopt the Fast Healthcare Interoperability Resources standard, or FHIR, say federal officials.

While the deployment of a single, consolidated electronic health record, called the Military Health System GENESIS, has the Department of Defense on a path to interoperability, the FHIR data standard that serves as its backbone isn’t congressionally mandated.

FHIR application programming interfaces streamline health information exchange by standardizing data and eliminating the need for sharing agreements, which is why the government required certified EHR vendors to make the APIs available to customers by the end of 2022. Still, unlike credit card companies, which have accepted data standards industrywide, the healthcare industry hasn’t fully rallied behind FHIR.

“We probably need to get the Chief Data Officers Council to make sure that it covers all the agencies. Congressional mandate, law is another tool,” said Ken Johns, CTO for the Defense Healthcare Management Systems Program Executive Office, at the AFCEA Bethesda Health IT Summit 2023 on Tuesday. “Probably what will be most successful is for industry to agree to standardize.”

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How Agencies Are Navigating Interoperability

DOD plans to deploy MHS GENESIS across all 700-plus Defense Health Agency facilities by the end of 2023. But two of DHA’s Joint Operational Medicine Information Systems products — the Operational Medicine Data Service and the Operational Medicine Identity Gateway — have struggled to achieve interoperability between EHRs absent data standards, said Product Manager Carla Voorhees.

The National Institutes of Health found that when gathering data on the social determinants of health, in accordance with a Biden administration executive order, the information comes in different formats, with different elements and on different platforms.

“We’re pushing FHIR to be able to integrate the different data,” said Samson Gebreab, program director for the Artificial Intelligence/Machine Learning Consortium to Advance Health Equity and Researcher Diversity at NIH.

The standard will improve not only scientific discovery at NIH but also the agency’s ability to address disparities, Gebreab added.

Similarly, the Center for Medicare and Medicaid Innovation is using FHIR to advance health equity.

“All of our new models are going to be required to collect data on beneficiary demographics,” said Arrah Tabe-Bedward, the center’s deputy director. “We’re also going to be looking to collect data on social determinants of health and ensure that we have access to that data to understand the impact that our models are having and whether they are addressing some of the gaps in quality and delivery of care.”

Ken Johns
It’s huge — the opportunity to have all of that legacy data and all of that new data in one place...”

Ken Johns CTO, Defense Healthcare Management Systems Program Executive Office

Healthcare Providers Benefit When Industry Participates

While standardizing on FHIR aligns with Biden administration equity priorities, healthcare providers will reap benefits as well, Tabe-Bedward said. 

DOD, the Department of Veterans Affairs and industry partners share health data through MHS GENESIS using the joint Health Information Exchange, which connects to about 122,000 healthcare providers. The FHIR standard, which allows for auto-ingestion of data from trusted partners, improves data transfer efficiency by reducing the burden on clinicians to manually input information, said Lance Scott, acting technical director for the Federal EHR Modernization office.

Soon the joint HIE will include long-sought-after data from state immunization registries, which FEHRM is working on with the Centers for Disease Control and Prevention.

In the past two years, FEHRM’s success in transferring data using FHIR has made it an “actual player” in national standards discussions, Scott said. The eHealth Exchange, a nonprofit health information network, reached out for help sharing data using FHIR.

“We cannot do any of this without close partnering,” Scott said.

DIVE DEEPER: How the VA is playing ‘catch-up’ on machine learning integration.

The Future of Electronic Health Records

Johns’ team at the Defense Healthcare Management Systems PEO is already working on the Revenue Cycle Expansion for MHS GENESIS. RevX will have a “huge” impact on patient administration by enabling military treatment facility administrators to make real-time, data-driven decisions, he said. Deployed forces will have access to new commercial software solutions for healthcare recording work, including the ViiMed platform and T6 Health Systems mobile application used in most medical trauma centers worldwide.

Between the data coming in from RevX software and the forthcoming immunization tracking and reporting tool, the MHS Information Platform will grow substantially with immediately actionable data, all thanks to FHIR.

“It’s huge — the opportunity to have all of that legacy data and all of that new data in one place to do Big Data analytics on, to bring in and leverage artificial intelligence, machine learning and data analytics,” Johns said.

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