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.

Methods

In 2021, federal health leaders are navigating this new era. Agencies can harness these data to support  their missions through a range of informatics, infrastructure, and insights-related capabilities:

Informatics: Data are only valuable if they are accessible and interpretable. Over the last few years, data standards organizations have made significant advances toward meeting these objectives in a robust and scalable manner. In particular, HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard and OHDSI’s OMOP standard are driving us toward a health informatics future where systems around the world can understand each other (i.e., semantic and syntactic interoperability) and efficiently communicate (i.e., RESTful APIs). Agencies can utilize these standards by:

• Developing implementation guides, profiles and extensions to address specific use cases (i.e., FHIR Profiling)
• Expanding data requirements to cover critical resources and elements (e.g., ONC USCDI ONDEC)
• Ensuring robust linkage across common data models (e.g., OMOP on FHIR)

Infrastructure: In order to leverage interoperable health data, agencies require platforms that exchange and store data securely. This infrastructure should be flexible enough to be deployed in a variety of environments and support a broad ecosystem of tools.  Agencies can meet these objectives through capabilities such as:

• Deploying on an open-source platform that enables portability across hybrid and FedRAMP-compliant environments (e.g., Red Hat OpenShift)
• Configuring servers to support conformance (e.g., IBM FHIR Server and HAPI FHIR), as well as software to analyze in diverse formats (e.g., IBM Project Alvearie)
• Connecting to federally aligned exchange networks and legal frameworks (e.g., eHealth Exchange)

Insights: Health data standards and platforms are only as valuable as the insights we generate using them. In the era of interoperability, federal agencies can efficiently scale capabilities to meet their nation-wide needs, including:

• Developing portable and precise algorithms (e.g., FHIR-based CQL and OMOP-based SQL), as well as natural language processing of clinical notes (e.g., cTAKES, ClarityNLP, spaCy)
• Building portable and secure applications (e.g., SMART Health IT App Gallery)
• Implementing intelligent automation of clinical and administrative workflows (e.g., FHIR Workflow)

Results

Agencies' interoperability-enabled use cases are as diverse as their underlying missions. Technical and policy stakeholders can identify opportunities to leverage these methods by reviewing success stories. Here are a few highlights of how early adopters are leveraging interoperability across the federal health domain:

• Regulatory: FDA’s specification of standards and algorithms to generate insights from real-world data (i.e., Adverse Event Reporting IG and USCDI submissions).
• Public Health: CDC’s development of SMART on FHIR apps to automate infectious disease case reporting (i.e., eCR).
• Provider: VA’s exchange of data to enable treatment, authorization, and clinical decision support capabilities (e., Veterans Health API).
• Payer: CMS’ development of APIs to drive burden reduction, quality metrics, care coordination, and patient access (i.e., BlueButton, Data at the Point of Care, and eCQI).
• Research: HHS and NIH’s creation of centralized platforms with de-identified clinical, administrative, and registry data to perform research studies (i.e., PCORnet and NCATS N3C)

Conclusion

Health data-related domains are complex and rapidly evolving. Government leaders can successfully navigate this landscape by participating in communities, such as HL7 and OHDSI, and by engaging experts with deep experience delivering these solutions, such as IBM Services’ Federal Health team.

To learn more about how our team can support agencies through technology agnostic solutions, join us at our upcoming HL7 event sponsor booths:

• May 24-28, 2021: HL7 Working Group Meeting
• June 7-10, 2021: HL7 FHIR DevDays
• September 20-24, 2021: HL7 Annual Meeting