The COVID-19 pandemic is helping to reveal new ways to use HL7’s Fast Healthcare Interoperability Resource (FHIR®) standard to share healthcare information and coordinate services, but systemic shortcomings in existing health information systems are hampering coordination of a national response.
FHIR is being used in some initial efforts to support public health efforts, and it has the potential to rapidly address approaches to gather data and coordinate research across the planet, said Wayne Kubick, chief technology officer for HL7 International.
“The FHIR platform can enable multiple apps to rapidly address urgent new use cases, such as public health,” said Kubick during a webinar on April 30, hosted by HL7 and sponsored by CitiusTech, entitled “Data Sharing in the Spotlight: COVID Gaps, Interop Rules and The Path Forward.”
Because FHIR enables data to be easily accessed by open source apps, it can help in the rapid response needed to the current pandemic, Kubick said. “Increased global adoption can help to get to a common platform of collaboration around the world; a FHIR infrastructure is the first step in a long process – to take advantage of this infrastructure, it will require further innovative, agile methods to build out implementation guides. Standards can’t solve the problem entirely – we need the infrastructure there to support rapid response capabilities.”
COVID-19 Initiatives Supported by HL7 FHIR
Kubick cited four examples of how FHIR was being incorporated into COVID-19 initiatives.
In one, HL7 is collaborating with Audacious Inquiry, a health information technology company on developing and testing a FHIR implementation guide for the Situational Awareness for Novel Epidemic Response (SANER) Project. The SANER Project is an industry effort to improve outdated and unreliable data sharing processes to increase awareness of healthcare system capacity for dealing with COVID-19 caseloads now, as well as future caseloads. For the current response, the SANER Project could track resources such as ICU beds and ventilators – the approach was tested last week at HL7’s Virtual FHIR Connectathon.
In Switzerland, an initiative called COVID-19 PROM is using a SMART on FHIR application to give patients questionnaires that they can fill out to evaluate their symptoms and report their data to healthcare organizations or the nation’s public health authority.
In Australia, a simple application called ClinicArrivals Documentation enables patients who may be infected with the virus to come to a clinic and remain in their cars instead of the waiting room, then uses a text message to notify them when it’s time to come in for the appointment.
Finally, the Logica Implementation Guide: COVID-19 aims to define FHIR profiles for key data elements associated with the virus. Logica Health, a not-for-profit formally known as the Health Services Platform Consortium and Clinical Information Interoperability Council, is coordinating iterative releases of COVID-19 and SARS-CoV-2-related clinical information models, value sets and interoperability resources. They will be available free of charge with the aim of rapidly producing semantically interoperable solutions across vendor platforms. Categories it’s focusing on include demographics, vital signs, exposure history, symptoms and more.
“There is a critical need for interoperability” in responding to COVID-19, Kubick said, acknowledging that data in electronic health records is often not mapped to existing standards, such as RxNorm or LOINC. “The Logica/HL7 COVID-19 implementation guide is intended to do that, and this is a critical function of each implementation guide. As we provide more conformance testing of implementation guides, supported by ONC testing, we expect this to improve – but it is a long process that we’re working steadily to improve.”
Kubick said it’s difficult to determine the timeline to roll out an infrastructure to handle the current pandemic but -noted that many providers already have the basic infrastructure in place to support a FHIR-based approach.
Indeed, a critical failing of electronic health records systems being used at U.S. hospitals is their inability to exchange critical information on COVID-19 cases with public health agencies that are charged with assessing the scope of the infection on states, locales and the nation, noted Aneesh Chopra, former chief technology officer of the United States and current president of CareJourney, a provider of clinical analytics for value-based networks.
“We’re seeing the failures of our public health infrastructure and it is an unfortunate circumstance,” he said. Citing the federal investment of more than $30 billion in incentives for healthcare systems to install EHRs, Chopra said the Centers for Disease Control recently said it typically does not get sufficient clinical context on about 90 percent of reported COVID-19 cases.
“We basically are getting phoned and faxed in results, with maybe an electronic feed on lab results, but without even basic demographics in some cases,” he contended. “This sad state of affairs is a call to action.”
Better data is crucial in handling the COVID-19 pandemic. “We want to make sure that we understand the current clinical composition of all COVID patients in the country,” Chopra said. “We want to make sure we have, as timely as possible, public health reporting, so we can more rapidly identify patients for contact tracing and self-quarantining so we can put out campfires rather than larger, more aggressive forest fires.”
Chopra noted that one effort involving FHIR could help national efforts to aid resource tracking tied to COVID. Currently, hospitals are obligated to report daily on resources related to the pandemic, such as how many patients are in ICU beds or on ventilators. That’s currently “a big manual burden,” but the Centers for Disease Control is in the early stages of testing a new SMART on FHIR app called Nandina, which will serve as an automated approach “to collect the necessary elements to feed resource planning efforts,” Chopra said.
Other initiatives are seeking to use FHIR to generally address gaps in patient care or better engage providers in meeting patient needs, said Swanand Prabhutendolkar, senior vice president for CitiusTech, a healthcare IT and consulting company.
Prabhutendolkar believes FHIR can support the industry in three areas that are crucial to the new payer ecosystem envisioned for the next decade. By enabling better data exchange, FHIR can improve member engagement, “providing solutions to bridge gaps in the care continuum and open the road to value-based healthcare delivery, which will improve clinical outcomes,” he said. In aiding provider engagement, it can help clinicians get easier access to patients’ longitudinal records and data. And across payer enterprises, it can support the integration of separate applications and systems to optimize workflows, achieving that goal by using different member- or provider-facing apps.
In one use case that CitiusTech envisions, a member can undergo a “seamless” experience for an inpatient admission if providers and payers are able to utilize FHIR to perform historically manual and time-consuming communicative tasks. Such tasks might include asking for prior authorization, managing documentation, providing notifications on an expected discharge date and length of stay, providing required clinical notes to the payer, and communicating information on remaining care gaps to a primary care physician.
Prabhutendolkar noted that the country is on a path to increasingly use FHIR, beginning with relatively simple (foundational) uses to achieve regulatory compliance with new federal requirements; progressive efforts, using FHIR to scale up and integrate information to achieve sustainable progress; and eventually transformational innovations that are value-adds for improved member and provider experience.