FHIR can cure fragmented healthcare
Reducing unnecessary emergency room visits through patient engagement and data analytics
Americans invented fast food, overnight shipping, meal kit services, and the 24-hour convenience store — we want everything available immediately and at our doorstep yesterday. Yet not all industries have been able to keep up with our need for quick fixes and convenience.
Healthcare, in particular, is struggling to deliver the Netflix-like experience consumers demand. It’s not a good sign when health insurance and the post office have similarly low customer satisfaction ratings.
When it comes to convenience, emergency departments (EDs) are the healthcare equivalent of your local 7-Eleven—widely available, open all the time, and stocked with necessities. But unlike 7-Eleven, EDs are expensive, slow, and limited in capacity. With ED visits outpacing U.S. population growth, the trend is going in the wrong direction. And its impacts include an increase in the size of your health insurance deductible.
One of the likely culprits in the rise of ED visits is our current state of fragmented care. We visit a doctor for one condition and a specialist for a different chronic issue, and neither doctor knows what the other is diagnosing and prescribing. This results in far-reaching real-world consequences: Patients with a chronic issue or two and fragmented care are 13 percent more likely to visit the ED.
Because ED visits are more expensive than other preventative and palliative measures, fragmented care comes at a cost. Care for patients who experience the most fragmentation costs twice as much as those with the least fragmentation. As healthcare premiums rise to untenable levels, creating greater customer dissatisfaction, the need to solve the challenge of care fragmentation has become more critical. Better patient outcomes and the long-term viability of the industry are at stake.
Solving fragmented care through interoperability
A technology challenge lies at the heart of fragmented care—how to get all of the data from multiple providers into one place and display it in such a way that doctors and patients can benefit. There is a solution, however, and it has been around for a few years. It’s called Fast Healthcare Interoperability Resources (FHIR). While the name is a mouthful, the concept is simple. FHIR is an architecture built in a common language for digitized medical records available in multiple healthcare applications in the healthcare ecosystem such as Electronic Health Records (EHR), Claims Processing systems, Population Health Management, medical devices, and health and wellness apps to name a few. FHIR delineates a well-defined next-generation framework for all of this data, which can be read by any system to support real-time, secure data exchange using APIs and modern web technology, regardless of the programming language used to develop it.
As a part of the 21st Century Cures Act, on March 9, 2020, the US Department of Health and Human Services (HHS) released their final regulations related to driving more interoperability and data exchange across the entire healthcare ecosystem. The government intends for the combined regulations to provide patients with timely access to their health data to make informed healthcare decisions and better manage their care. Providers, Payers and Healthcare IT vendors are expected to comply with enabling a set of FHIR APIs available starting 2021 through mid-year 2022, as well as to refrain from acts of “information blocking,” or else risk civil monetary penalties and public reporting of non-compliance.
If FHIR APIs are the foundation, then microservices, or the process of developing technology services as small, autonomous applications, is the latticework that enables the structure to be built. The outcome is an architecture that enables rapid development and is flexible without compromising the overall structure, scalable yet modular, and cloud-based. But what does this mean for the people on the ground—the patients and doctors?
FHIR directly impacts patient outcomes
FHIR can help ensure that patients receive more informed care in the most appropriate setting, reducing cost while improving their overall health and quality of life. Let’s take a look at a sample use case of how PK’s solutions developed on FHIR work to create positive patient outcomes.
Enhancing Patient Engagement Experience
Nikki has persistent and severe asthma. Nearly 8.3 percent of the U.S. population has asthma, and of those, 56 to 74 percent have severe asthma, so Nikki’s case is quite common. When Nikki has a complication related to her asthma, she frequently ends up at the ED for care. Her need to utilize the ED isn’t an outlier – in 2017, there were over 1.5 million ED visits due to asthma. Because the ED doctors don’t have access to medical records from her allergist and general practitioner, they run duplicative tests. Her medical expenses soar while her condition remains unchanged.
Fast forward to next year: Nikki has changed insurance companies and now belongs to a provider group that employs a patient portal app similar to the one developed by PK below. It’s accessible through her smartphone and gives her the information she needs to make smarter health decisions.
The app enables her to access her records from different doctors while also capturing her interactions with the app and providing helpful information tailored to her specific condition. Her appointments, her communications with doctors, and her test results are all available at her fingertips. This is what FHIR looks like from the patient’s perspective. Since asthma is often exacerbated by seasonal flu, the insights-driven mobile application also reminds her to get her flu shot.
Visualizing patient and population-level insights
PK’s CareQuotient is a data management and analytics platform for healthcare providers and payers. Nikki’s data is fed into CareQuotient, as is the data of every other member of the healthcare group she belongs to. CareQuotient visualizes Nikki’s data so her providers can analyze and make informed decisions about her condition as well as the health of the entire population they serve.
With CareQuotient, providers can view dashboards that display the number of times patients have visited an ED. This can help providers track the population’s propensity to go to the ED as well as insights on how many of those are avoidable. As providers work to reduce the number of unnecessary ED visits, they can use this data to respond with targeted messaging to patients via the mobile app. CareQuotient can also be used to deliver training to specific doctors with lower-than-average outcomes, then measure the effectiveness of their interventions. This is what FHIR looks like from the provider’s perspective.
As fragmented care continues to drive greater numbers of ED visits and increased healthcare premiums, health insurance and providers find themselves on the brink of a major disruption. Trends in the political space towards single-payer and Medicare for all are a miner’s canary for the industry. Whether that disruption is led by healthcare companies or forced upon them will be determined by industry leaders’ ability to adopt new technologies to address long-standing issues.
FHIR is only one example of a transformational technology moving healthcare forward. The wide-ranging possibilities of its use, its large throughput, and its readily available technology make it more accessible and impactful. This means those providers and payers that neglect its potential do so risk their competitive advantage at the expense of their patients.
About the Author
Ham Pasupuleti has held strategy and operations roles in the IT industry for more than 27 years, implementing and managing business-critical applications and systems infrastructure for Global 1000 companies. At PK, he provides business analytics and optimization solutions to healthcare organizations, enabling them to transform into outcome-based delivery models that are high quality, accountable, patient-centric, and cost-effective.Tags: Analytics, Carequotient, emergency room overuse, FHIR, fragmented care, health insurance, healthcare analytics, interoperability, Mobile App Development, patient access, patient outcomes, patient portal, Redhat