FHIR for Patient & Provider Master Data: Where to Focus

You know the problem all too well: healthcare data is growing exponentially, as is pressure to store and share that data. Yet too much data remains trapped in siloed EHRs, and inconsistent standards make data sharing difficult, fragmented, or untrustworthy.

That’s why FHIR (Fast Healthcare Interoperability Resources) was developed in 2012 to foster better data exchange among healthcare providers, payers, and patients.

Some organizations have been reluctant to jump into FHIR, even as legislative mandates emerge. And as standards continue to evolve, FHIR can seem overwhelming.

Never fear. You don’t have to do everything all at once. We can help you understand how FHIR can become an asset for your organization, then chart out a measured FHIR strategy that works for you, now and down the road.

In this post, we’ll:

  • Review the basics of FHIR (Fast Healthcare Interoperability Resources)
  • Explain how the standards have evolved
  • Explore how FHIR can help with patient and provider data needs, especially from an MDM perspective

What is FHIR? Why should I care?

Healthcare data is complex, with special considerations for privacy. And it’s based on documents — traditionally shared via paper, fax, or PDF — that can be too cumbersome for decision making, care coordination, or analytics.

FHIR defines how healthcare information can be exchanged, regardless of how it is stored. FHIR allows clinical and administrative data to be made securely available for those who need it to deliver patient care.

Today, FHIR is enabling better access to healthcare data regardless. Developers use FHIR to build applications to bring this data into their ecosystems in a manner that’s more useful than PDFs or spreadsheets.

FHIR standards are fueling the growth of the healthcare internet of things, such as wearable devices and monitors. In turn, FHIR helps ensure that the data generated by these devices is usable and can help providers make decisions about patient care.

For example, FHIR makes it possible for patients who see providers in multiple health systems to have a single, complete record that unites their history, allergies, medications, and other information to help ensure continuity of care.

What’s the timeline for FHIR implementation? 

Release 5 occurred in late 2022, and FHIR continues to evolve. A 2021 survey found that only 24% of healthcare companies are using FHIR APIs at scale, but that number was expected to grow to 67% of providers and 61% of payers by the end of 2023.

Either way, FHIR is coming, and you will need to eventually comply. The sooner you can begin, the more thoughtfully you can go about your implementation. This approach will smooth out your path for future iterations. Plus, you’ll gain more flexibility and efficiency by baking FHIR into your existing tech stack and integrations.

What does SMART on FHIR mean?

The SMART Health IT project created an API that enables an app to be written just once and then run anywhere within the healthcare ecosystem. Over ten years, SMART has evolved into a standard across health information technology, providing an interface between healthcare data and innovation.

Today, SMART supports an App Store for Health that includes projects such as Apple Health Records API, Microsoft Azure SMART API, CMS Blue Button 2.0, and many others. The SMART on FHIR API is now built into major EHRs and can be utilized as a new interaction method to data management hubs and EMPIs.

The SMART team drove requirements for APIs in the 21st Century Cures Act, and evolving rules from CMS and the ONC are making SMART a requirement.

Why implement FHIR queries for your patient master data / EMPI?

Most of the use cases and mandates around FHIR API support focus on EHRs that house extensive clinical data. Leveraging FHIR with your EMPI lets you disseminate and provide access to patient demographic data in a controlled, safe, secure manner – without ever exposing your systems that store actual clinical information.

Similar to HL7 v2, you can consume demographic or clinical data from external systems, send data and updates from the EMPI out to external systems, or query both in and out of the EMPI. 

While all of these are useful, the primary focus for quick wins is the query. Setting up a FHIR query service for MDM creates an integration point for HIE queries. The data from these queries can enrich your healthcare region’s ecosystem while building a more complete picture of each patient. It also will help you meet regulatory requirements around data sharing. While HL7 v2 already supports query via PIX/PDQ, a JSON structure allows more versatility and flexibility compared to REST APIs. 

Implementing FHIR can also help strengthen security. Originally, much HL7 traffic was implemented without SSL. Moving to REST and HTTPS (which defaults to SSL) increases the security of your transactions. This is especially important when integrating with external sources such as HIEs.

Eventually, additional interface points A08s and A31s that propagate registrations and updates in and out of clinical and EMPI systems can also be moved to FHIR. 

However, starting with query will generate the most immediate value. It will help your organization comply with the Cures Act and gain experience to more quickly implement the rest of your healthcare messaging.

Which FHIR resources are relevant to Provider Master Data?

CMS mandated that health plans and payers implement a FHIR API-enabled provider directory through the Interoperability and Patient Access Final Rule by July 1, 2021. That date has come and gone, but many entities are still not compliant. 

Up-to-date access to provider network status is also foundational to the No Surprises Act.  While open source implementation guides are available through the Davinci Project, they can be complex to tackle alone.

First, you need to be sure that you can model the complex objects and relationships that are relevant to individual practitioners and health delivery organizations. This includes both clinical and financial data.

These models must include provider accessibility information that allows patients or referring providers to locate the most up-to-date details before engaging in services. They also should include information to enable electronic exchange, such as transactional endpoints for EHRs, HIEs, and direct communication addresses (i.e., email).

The Practitioner resource is designed to capture information about individual healthcare professionals involved in patient care. When managing and interacting with the Practitioner resource, focus on:

  1. Searching for an existing provider based on name, specialty, location, insurance, etc.
  2. Registering new providers with their contact details and other information.
  3. Reading or retrieving detailed information about locations, services offered, and affiliations.
  4. Updating existing provider data to reflect current insurance and in-network status.
  5. Deleting providers to maintain the integrity of the directory data.
  6. Batch updates, which are much more common integration patterns for provider and organization data compared to real-time patient data updates.

A master data platform such enables you the flexibilty to quickly model the multiple domains and relationships required to create the 360-degree view of providers in a FHIR-compliant way. 

Get started with FHIR or expand your use

Ready to proceed with your own FHIR project? Contact us to discuss which FHIR interfaces fit your organization’s needs. With extensive experience in integrating both patient and provider data across healthcare systems, HIEs, HHS, and government services, IMT can help you chart your plan and priorities for FHIR-enabled solutions to meet current mandates and strategic priorities.