The Standard

Federal health agencies have entered an era where data interoperability-enabled solutions play a critical role. Government leaders can harness the innovative and proven capabilities referenced in this article to deliver on their essential missions.

Background

In 2020, two major events laid the foundation for this era of interoperability.

Pandemic Response: The first was the coronavirus pandemic, which led to unprecedented needs for health data in support of agency missions. Since its start, decision-makers have required more access to and insights from these data (e.g., clinical records, administrative claims, patient experience) than ever before.

Interoperability Rules: The second was the finalization of the ONC and CMS-led 21^st Century Cures Act interoperability rules. These mandates substantially expanded agencies’ ability to leverage health data solutions (e.g., algorithms, applications, and automation) at scale.

Social Determinants of Health Data Matter for National COVID-19 Response Efforts

The Gravity Project is pleased to announce the publication of its consensus recommendations for food insecurity, housing instability and homelessness data elements. The Gravity Project is a national cross sector grassroots informed collective charged with building consensus data elements and data standards for the capture, exchange, and use of social determinants of health (SDOH) information. The Gravity food insecurity and housing data elements are the result of a year of development with input from its over 1,000 participants with intentional representation from key stakeholders such as patients, providers, community based organizations, payors, technology vendors, and federal and academic food insecurity and housing subject matter experts.

Social determinants of health—the circumstances in which we are born, grow, live, work and age—are estimated to account for 80-90% of health. There is growing interest from the healthcare sector to integrate social risk evaluation and intervention to advance the triple aim: improved health outcomes and quality of care while containing costs. In 2018, Gravity founders University of California San Francisco (UCSF) Social Interventions Research and Evaluation Network (SIREN) conducted an assessment of existing SDOH data and found much work was needed to advance the documentation and use of this data. Enter, the Gravity Project. The Office of the National Coordinator for Health Information Technology (ONC), a Gravity Project sponsor, noted the growing recognition across healthcare that by capturing and accessing SDOH data during the course of care, providers can more easily address non-clinical factors, such as food, housing and transportation insecurities, which can have a profound impact on a person’s overall health.

Report from Virtual FHIR DevDays 2020

A New York State initiative is aiming to change its approach for exchanging patients’ health information among the state’s health information exchanges, using HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard as the conduit.

In addition, the new approach being implemented for the State Health Information Network for New York (SHIN-NY) has taken less time to develop and is expected to enable the exchange of more granular patient data than is possible with the current approach.

Speaking at the HL7 FHIR DevDays virtual meeting on June 15, Luke Doles, senior director of services management for the New York eHealth Collaborative (NYeC), said further implementation of the FHIR-based framework has been delayed because of the urgency to shift resources to support the state’s COVID-19 response. However, the initiative has thus far proven that the concept can be expanded to provide more information across SHIN-NY.

Report from Virtual FHIR DevDays 2020

Work on incorporating application programming interfaces using HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard can help healthcare organizations better manage the COVID-19 crisis, but much more could be done.

A virtual panel at HL7’s FHIR DevDays indicated that API usage can help with the sharing of data, but more widespread use of this supportive programming could provide more benefits.

“If you look inside the typical hospital, there are more than 20 different clinical systems being used, but only one is the electronic health record getting the API love,” said Keith Boone, enterprise architect for Audacious Inquiry. “COVID data is showing up in bed management systems, command and control systems, ICU central monitoring and more.” Those systems are five years behind EHRs in enabling data exchange.

Report from Virtual FHIR DevDays 2020

A new initiative is making rapid progress in developing a way to improve how providers report COVID 19 data to public health agencies.

Started in late March, the Situational Awareness for Novel Epidemic Response (SANER) Project has made “huge progress in a short period of time,” said Keith Boone, enterprise architect for Audacious Inquiry, a consulting firm that helped to start the initiative.

HL7 collaborates with the U.S. Centers for Disease Control and Prevention (CDC), the Council of State and Territorial Epidemiologists (CSTE), and the Association of Public Health Laboratories (APHL) to support eCR Now through the use of HL7 FHIR in the nationwide initiative formulated for the rapid roll-out of automated electronic case reporting (eCR) from EHRs to state and local public health agencies.

HL7 is developing the SANER HL7® Fast Healthcare Interoperability Resources (FHIR®) Implementation Guide (IG) to support standards-based communication to emergency response authorities regarding critical COVID-19 resources such as ICU beds, ventilators and other essential equipment and treatment supplies. Audacious Inquiry is leading the development of open source solutions that will follow the SANER HL7® FHIR® IG.