Simplifying data sharing to improve health outcomes

Healthcare is generating more data than ever—and the analytics market is projected to grow from $44.8 billion in 2024 to $133.2 billion by 2029, driven by advances in predictive modeling and personalized care tools.

But as data volumes surge, hospitals, healthcare providers, and public health agencies face a more urgent challenge: the ability to securely exchange information in real time. Rapid, reliable data sharing is essential for managing emergencies and addressing major threats like heart disease, cancer, substance use, and suicide.

The rise of FHIR®

The federal government recognized the need for interoperability in the late 2000s. Over the past 10+ years, Congress has passed laws and the Centers for Medicare and Medicaid Services (CMS) has introduced rules to push American healthcare organizations to modernize their data operations, including:

• The 21st Century Cures Act (2016) mandated the development of the Trusted Exchange Framework and Common Agreement (TEFCA) to enable network-to-network health information exchange and required certified health IT to support standardized APIs.
• The CMS’s Meaningful Use standards established specific criteria for EHR use to improve care quality, which later evolved into the Promoting Interoperability Program in 2018.
• The CMS Interoperability and Patient Access Final Rule (2020) requires Medicare Advantage, Medicaid, Children’s Health Insurance Program (CHIP), and Qualified Health Plan (QHP) issuers to implement APIs for patient access to health data.
• The CMS Advancing Interoperability and Improving Prior Authorization Processes Final Rule requires payers to establish APIs to share patient health information.

In each of these cases, the government has endorsed FHIR® (Fast Healthcare Interoperability Resources) developed by HL7® (Health Level Seven®), to facilitate the move toward interoperability.

What is FHIR®?

FHIR®, developed in 2012, is a set of best practices and open standards developed by a global community to make data sharing more flexible and effective. Earlier data standards (V2, V3, and CDA) exist, but FHIR® delivered several advantages, including:

• The use of concepts familiar to software engineers, reducing the learning curve.
• Implementation guides for agencies and organizations.
• Enabling the creation of apps, similar to how public APIs facilitated the rise of services like Uber and Airbnb.
• Standardized analytics and secure data exchange.

Federal agencies are already implementing FHIR® in their data modernization efforts, and their work is providing valuable insights for leveraging these tools.

Why FHIR®?

Interoperability standards can help healthcare providers and organizations remain compliant with federal laws. To comply with federal laws, medical providers must report annual quality metrics to CMS. While there are some standards for data exchange, reporting is complicated by differences in EHR systems.

FHIR® APIs allow standardized queries to gather quality-of-care data and generate reports. For example, a CMS quality measure for diabetes requires a yearly eye exam for each patient. FHIR® can query provider EHRs for relevant procedure codes, streamlining the reporting process.

Recent health crises also underscored the importance of interoperability in responding to emergencies. In 2020, public health agencies at all levels scrambled to obtain data from hospitals overwhelmed by patients. In the absence of centralized guidelines, hospitals developed their own approaches, which introduced variability and complexity into the response process.

The Helios FHIR® accelerator project aims to solve these issues by simplifying data sharing between hospitals and public health agencies. ICF is investigating how FHIR® APIs can be integrated into existing EHR systems to standardize tracking of aggregate data, such as ICU beds, ventilators, and personal protective equipment, enabling agencies to quickly access real-time data.

Best practices for FHIR® implementations

Agencies and developers can take these steps to accelerate FHIR® implementation:

• Use the HL7 registry: This centralized resource provides access to implementation guides, specifications, and reference materials developed by HL7 work groups and partner agencies.
• Consult open-source products: Tools like HAPI FHIR® enable rapid setup of compliant implementations and can serve as a reference for future deployments.
• Participate in HL7 Connectathons: These hands-on events provide a forum for organizations to engage with the FHIR® community and test new implementations alongside peers.
• Host a FHIR® hackathon: These innovation-focused gatherings unite technologists, clinicians, and policymakers to co-create practical solutions that enhance data sharing and interoperability.

FHIR® is vital in the age of AI

Interoperability’s importance will only grow, not shrink, as agencies and healthcare organizations implement and scale their AI applications in the coming months and years. Agencies must leverage FHIR® now to ensure they’re primed to get the most from their AI investments. To see how these principles are being put into practice, explore how we support CMS in advancing eCQM standards and data harmonization.