FORBES 2020 ashish-kachru-fhir-apis-forbes20-800x500
We live with the irony of stunning technologies saving lives in the operating room at the same time we have fax machines humming away in the back office  Ashish Kachru, Altruista Health Chief Executive Officer 
Oct 12, 2020

FHIR Fever Is Catching On In Healthcare

by Ashish Kachru

(This article first appeared in Forbes. Ashish is a member of the Forbes Technology Council.)

Nearly 20 years ago, as I visited my home country of India, I ran low on cash and had to stop at an ATM to replenish my funds. The ATM spit out the rupees I needed instantly and correctly, even though my U.S. dollars were housed in an American bank. Earlier that month, I had used that same ATM card to get U.S. currency in Columbus, Indiana. Had I been in Mexico needing cash, the ATM would have given me pesos. Thanks to forward-looking leadership in the worldwide financial sector, one language for many countries and many currencies makes this small miracle possible.

We can’t adopt a uniform data language in healthcare fast enough to suit me. We live with the irony of stunning technologies saving lives in the operating room at the same time we have fax machines humming away in the back office. As the CEO of a healthcare technology company, I look forward to the day when open-source technology in healthcare is no longer a buzzword but a fact of day-to-day life – one that will save lives and bring down costs in dramatic fashion.

Interoperability Is Urgent

It’s been almost two decades since the nonprofit Health Level Seven International (HL7) created the FHIR standard, now on its fourth release. The forces of government regulation, consumer demand, competition and the journey to value-based care are creating new pressure on the healthcare industry to embrace interoperability, a Deloitte report says, with FHIR emerging as the common language. Open standards to link diagnostic, clinical health and certain administrative data can reduce medical errors, eliminate opportunities for fraud and bring down the data siloes that account for so much waste.

I am most excited about the Da Vinci Project, a private-public initiative tackling value-based care in which payers and providers are working toward the adoption of HL7 FHIR to connect stakeholders. They are developing use cases around the most expensive fault lines in the healthcare system: gaps in care and information, identification of emerging member risk, and patient transitions between levels of care, especially in emergencies. Small errors in these situations can quickly turn expensive and unsafe. One of my own employees spent Christmas Day with her father in the hospital after a small oversight in a prescription order brought him back to the emergency room just a few days after he’d been discharged. The resulting round of new tests and two inpatient nights cost Medicare thousands of dollars – all avoidable.

Less Friction, Faster Care

Common standards could ease friction between providers and payers in the current preauthorization process in which payers review treatments and procedures against the latest clinical standards and costs, currently a painful experience for everyone involved. With a common-standard application programming interface (API), a preauthorization request could extract relevant medical data from the provider’s medical record software as part of generating the request. This data could be bounced off the accepted clinical guidelines and fend off a human-driven set of questions and responses intended to weed out medication conflicts, redundant lab screenings and medical contraindications. Most authorizations would fly through in near-real time while raising the profile of cases that required extra attention.

Fevers And Red Flags

There could be many other examples, as seen in other parts of the economy. Amazon Web Services Marketplace offers more than 7,000 digital software apps in its marketplace ready to plug and play, thanks to uniform data standards. A marketplace for healthcare APIs with published standards would drive innovation among technology vendors. If someone were to create a top-notch patient management app, an API could link it to a care management platform housing a consumer’s full medical record. If a patient’s blood sugar, fever or heart rate were on the rise, it might mean nothing at all – or it could be a red flag in the presence of an existing medical condition.

For example, a rising fever can be an early sign of the flu, which presents a greater risk in an elderly person. A care manager alerted to the fever could advise the patient to seek out anti-flu medications that are most effective when taken in the early stage of infection. That patient might change their behavior to avoid exposing others, such as rescheduling a visit with their grandkids. Multiply this by millions of patients with nuanced health profiles, and you see the potential.

The Lancet Digital Health (via Reuters) released a study showing that the combined heart rate and sleep data from 47,000 Fitbit users helped predict and speed the response to flu outbreaks in five states. As well as helping individuals, could this be the way to anticipate and manage the next coronavirus?

A key challenge will be establishing trust in the concept as well as the practice of data interoperability in healthcare. No one advocates that we take patient privacy less seriously, but this does create a quandary. State and federal privacy and security regulations protect data and penalize violations of patient privacy, but they can also inhibit ideal clinical care. For example, an API might be strongly advantageous to a person’s health, but who accrues the penalties if there’s a breach while the API is in a handshake mode as information is exchanged?

In 2019, the Department of Health and Human Services proposed an interoperability rule that prompted Congress to raise concerns about data safeguards. Making interoperability viable and sustainable for the long term won’t be easy with data protections firmly at the forefront. The challenge is how the industry can work together to adopt a workable solution that respects not just the consumer, but also technical evolution.

The financial services industry took the lead in demonstrating that interoperability is possible. Healthcare is known for lagging behind in certain technologies – hence the fax machines – but the stars are aligning to bring the industry up to speed. It’s a huge, worthwhile effort. As people enjoy the many personal conveniences technology has delivered, they’ve developed the expectation that healthcare should work the same way. They are right.

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