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"The Dish on Health IT"

Engaging discussion around Health IT with perspectives from across the healthcare landscape. This informative and entertaining rotating panel of senior health IT consultants and their guests will keep you in the know about the latest innovations, policies and industry shifts impacting healthcare and point out the opportunities that lie within.

The Dish on Health IT

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Episode 7: APIs, FHIR Accelerators & Infrastructure


Guest, Patrick Murta, Solution Architecture Fellow with Humana and Chief Architect for the ONC FHIR at Scale Taskforce (FAST), joins hosts Gary Austin, Jocelyn Keegan and Ken Kleinberg to discuss how Fast Healthcare Interoperability Resources (FHIR) is transforming health data exchange and what HL7 FHIR Accelerators are doing to expedite progress and FHIR adoption.


Gary Austin kicks off the discussion by asking Murta a couple of level setting questions. Why are FHIR APIs so different from legacy EDI transactions? Is this just an IT thing or is it a generational technology and business change? Murta explains that FHIR allows integration from not only an administrative perspective but also a clinical perspective. Information can now be served directly into the workflow at the exact time it’s needed. FHIR enables business and clinical processes that were not yet possible with previous generations of technology.


Gary shifts focus to FHIR API Accelerators. He mentions POCP is a program manager for the Da Vinci FHIR Accelerator, has representation on CARIN (consumer-facing accelerator) as well as Gravity (social determinants of health accelerator). How do these accelerators “accelerate” the adoption of FHIR APIs? There are two important factors contributing to this acceleration: the technology (FHIR) and the cross-industry agreement and willingness to collaborate. Put these two things together and you can achieve much more, much faster than if operating ad hoc across the industry.


On top of the FHIR API accelerators, there is FAST (FHIR at Scale Taskforce). Gary asks both Murta and Jocelyn to weigh in on the subject, including an overview, its origins and why it’s needed. Murta notes the reason FAST exists is due to the development of “functional consortiums” like Da Vinci, CARIN and Gravity. Those groups focus on functionality whereas FAST focuses on the infrastructure capabilities needed to run those functional use cases at scale. FAST was created to identify any barriers to scalability of FHIR and create the appropriate tiger teams to start coming up with solution frameworks to address those problems.


Jocelyn points out that implementations happening today are targeted toward point-to-point traditional connections, but everyone that is building is asking themselves how I can reuse and leverage this API over and over again with all of my business partners. Although those questions are not being answered right now, implementors are evaluating how and where they can take advantage out of the recommendations and tools coming out of the FHIR community and specifically FAST .


Gary asks Murta how he balances the details of specification and implementation guides with the galactic vision of accelerating the entire industry? Murta says it is rather easy to separate the different parts of the technology stack. With Da Vinci, the focus is on solving something for a stakeholder in healthcare (use cases). How would the provider, clinician or member interact with this data? Where do they need it in the workflow? What information do they need? On the other hand, with FAST, there is an emphasis on core capabilities and infrastructure. What do these transactions look like when flowing through the technical layers? What identities are going to be used?


Jocelyn goes on to explain the temporal dimensions of the matter. What happens in 2020 with respect to these accelerators? Where do you see 2021 going? Jocelyn states that the current pandemic reveals why these workflows are critically important and how we need to move forward as an industry. In spite of the world we are living in now, Jocelyn is excited that we will exit 2020 with some good production implementations of Da Vinci implementation guides and start to see real recommendations coming out of the FAST community. She believes 2021 will be about continuing to finetune and support the wave of people needing to implement.


The discussion pivots to Ken as Gary addresses a significant problem plaguing the industry: identification at the human level. How do we take the intricacies of TEFCA (Trusted Exchange Framework and Common Agreement) and deliver that at scale? Ken explains that TEFCA is the federal government’s latest attempt to connect the network of networks. It is voluntary and still in the development phase. TEFCA is being designed to address three modes of communication, including message push, targeted query and broadcast query for the information retrieval. FHIR is a newer approach to information exchange and its heavily used in the new ONC final rules. Ken believes it is likely FHIR will be included in future versions of TEFCA.


What are challenges for accelerators? Murta worries that as we get additional accelerators, there may be saturation. The industry must keep in mind there are a finite number of resources available to accelerators. It would be detrimental to spread the scope too wide, only to halt forward momentum.


Gary asks Murta one final question. What would you tell an executive business leader in a payer or an IDN who may not be behind this interoperability transition? Murta would tell them to look where the industry is going. You owe it to yourself, your customers, your patients and providers to look at this. If you’re not recognizing the value of this technology, you’re not fully optimizing your processes.


Jocelyn concludes the discussion by promoting everything being built in the FHIR community. She says it is available for anyone to pick up and use.