MyMipsScore: The Complete MIPS Solution - Benefits of FHIR for Providers

HL7® FHIR® standard is no longer a strange term in the provider world. It has emerged as the widely adopted data standard. Even as the promise of interoperability through FHIR is beginning to materialize, many providers are stuck wondering “What’s in it for me?” In fact, provider organizations of all sizes stand to benefit greatly from both a clinical and business perspective in the form of efficient clinical workflows, better patient outcomes and regulatory compliance. FHIR has the power to simplify or eliminate many administrative and care-coordination tasks leaving providers with more time and resources to focus on their patients.

HL7® and FHIR® are registered trademarks of Health Level Seven International.

So How Does FHIR Help?

FHIR can seem a bit complicated for those who aren’t familiar with the technology backing it. For this discussion we can simplify this a bit and say that FHIR creates a standard data set which allows different applications and systems to send, receive, and share data rapidly. This standardized data set would apply to both providers and payers, allowing for two-way exchanges of data with Medicare, Medicaid and Commercial payers.

FHIR enables three main goals:

Care Coordination
Patient Engagement
Regulatory Compliance and Research

Let me illustrate with the help of some of the CMS initiatives for which interoperability of health data is the fountainhead.

1. Provide Patient Access and Health Information Exchange

As the Merit Based Incentive System (MIPS) impacts provider organizations big and small, let’s look at the impact of FHIR in the context of MIPS first. In a previous blog we discussed how FHIR can drastically reduce MIPS reporting burden felt by many providers today by taking away some of the labor-intensive functions required for MIPS compliance.

For instance, under the MIPS Promoting Interoperability Category providers must Provide Patients Electronic Access to Their Health Information within four business days of receiving it. They are also required to Support the Electronic Referral Loop by being able to send, receive and incorporate data for patients referred to them and the patients they transition to other provider organizations. With FHIR, that data could be made available instantly and automatically. Eliminating a burden that weighed heavily on many healthcare providers. This MIPS requirement goes way beyond MIPS scores and accompanying reimbursement adjustments, it impacts the patient’s quality of care and sometimes their life.

2. FHIR API Required for Alternative Payment Models

Alternative Payment Models (APMs) is a payment approach adopted by CMS that awards added incentive payments to provider organizations for delivering high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population that includes MIPS APMs (e.g., MSSP ACO Track 1,1+, 2 & 3, Nextgen ACOs) and Advanced APMs (e.g., CPC+, Comprehensive ESRD). CMS recently introduced some new specialty-specific payment models that build upon the existing APMs (e.g., Kidney Care Choices (KCC), Primary Care First) . All of these payment models require providers to use an EHR that is capable of sharing data via FHIR APIs to satisfy the goal of these payment models, enhancing the timely exchange of provider-validated patient health information that enables:

Increased Patient Participation
Improved Care Coordination
Improved Patient Care
Improved Diagnostic and Patient Outcomes
Increased Practice Efficiencies and achieve Cost Savings

3. Data at Point of Care Initiative (DPC)

DPC allows healthcare providers to import healthcare data for their patients directly from CMS using claims data. A healthcare provider must have a treatment related purpose for viewing a patient’s claims history. Providers can attest to their treatment purposes by submitting an “attribution roster,” which lists the patients currently under their care. Once enrolled, a provider will be able to receive this data with a simple click. CMS took this initiative to enhance the care of over 53 million Medicare Beneficiaries.

Imagine being able to lower or even eliminate the costs behind prior-authorization requests by making the data sharing process between your EHR and the insurance company seamless. Or, imagine being able to answer requests for medical records instantaneously thereby drastically reducing the amount of labor and time required to work through denials.

While initially, this will only apply to CMS data (Medicare and Medicaid), when the proposed rule CMS-9115 (Interoperability and Patient Access Rule) goes into effect, other payers will be required to follow suit to increase the benefit of sharing provider-validated data on a timely basis.

4. Chronic Care Management

Chronic Care Management is another area that stands to benefit significantly from the introduction of interoperability, especially with time as more and more data get accumulated into the system. As data aggregates and trends are identified, providers will learn more about specificities of chronic illnesses and will be able to use that data to introduce more effective preventive care for patients with multiple comorbidities.

Outside of the office, patients will be able to follow in near real-time as test results and notes are aggregated in their EHR. They will then be able to take that data and turn it around quickly to solicit second and third opinions or to seek out tumor board review.

5. Care Management

Improving Care Management is another obvious benefit of increased interconnectivity and interoperability. For example, multiple FHIR systems interconnected with each other will allow providers to identify warning signs among patients who are at high risk of multiple comorbidities. Identifying these patients and issuing preventive care will increase the long-term outlook for those patients and reduce costs on the overall system. Imagine, for example, a diabetic patient who can test their blood sugar and have data outside the normal range be automatically registered with their provider without having to remember to write it down or bring it with them for the office visit.

Additionally, FHIR APIs enable patients to take an active role in their own well-being by facilitating the fast and secure exchange of information. Patients would receive even greater access to their medical data in a standardized format, which opens developers like Microsoft, Amazon, Apple, and Google to develop apps that not only study and learn from a patient’s medical history but can transmit data back to the provider as well. It’s no surprise that these tech giants are backing FHIR.

6. Benefits of Interoperability for Providers

Providers stand to gain on multiple levels in an interoperable healthcare ecosystem fueled by FHIR APIs. By giving and receiving access to the right data at the right time provider organizations would be able to:

Provide better coordinated and timely care to their patients
Enable increased patient safety by eliminating medical errors
Reduce unnecessary/duplicate diagnostic tests
Achieve greater patient engagement and satisfaction
Reduce medical liability
Attain regulatory compliance with ease

Finally, when looking at the overall picture we can see that the administrative work could be reduced significantly. Less time will be spent on phone calls and documentation of data that was already documented elsewhere. This means that employees previously focused on non-value generating activities can redirect their efforts toward activities that directly benefit the patient.

How Easy is it to Get Started?

While many of these benefits may seem far-fetched, much of this is becoming reality right now. Systems like BlueButtonPRO™ are available today and able to integrate with CMS systems to pull in patient information in seconds. Getting your patients enrolled is quick – as easy as setting up an email account. It’s easy for you to manage patient access and easy for your patients to use as well. Most important of all, it is safe and secure to use. BlueButtonPRO™ uses the latest security standards including OAuth – a standardized protocol that is widely used in the tech industry to make sure that the transfer of data is seamless and secure.

BlueButtonPRO™ provides you the capability to:

Connect and Provide Access to Patients: Provide electronic access to your patients securely to not only meet regulatory requirements for MIPS, but also engage patients in their care.
Incorporate Patient Data: Accept FHIR enabled data from other providers, health plans, health apps and fitness trackers that patients share with you. Incorporate this data into the patient chart to get a more complete picture of the patient's medical history.
Exchange Data with Other Providers: Send and receive referrals and summary of care to ensure continuity of care for patients. Smoothly transition your patients to other facilities, prevent medical errors, and avoid unnecessary tests and procedures.
Connect to Apps: Connect and use FHIR based apps with the aggregated data for medication adherence, medicine dose calculations, risk assessment for certain conditions, and other general and specialty-specific apps to provide better care to your patients.

FHIR has matured to be a safe, secure data standard that is paving the way for semantic interoperability. It’s obvious now that as data becomes ubiquitous this will encourage future innovation. For those who become early adopters, the benefits will be even more significant as the access to game-changing data will help them provide exceptional care to their patients and grow exponentially. Those who decide to wait for regulatory compliance to force their hand may find themselves playing catch up.