Why Health Payers Should Invest in FHIR Despite Low Utilization of the Patient Access API

In recent years, the healthcare industry has undergone significant transformation, driven by regulatory changes and technological advancements. One of the pivotal elements of this transformation is the Fast Healthcare Interoperability Resources (FHIR) standard, designed to facilitate seamless exchange of healthcare information. However, despite the potential benefits, the utilization of the Patient Access API, which relies on FHIR, has been lower than expected. This raises a pertinent question: why should health payers invest in FHIR when the uptake of the Patient Access API has been minimal? This article explores the strategic reasons for health payers to invest in FHIR, highlighting its long-term benefits and transformative potential.

Understanding FHIR and the Patient Access API

FHIR, developed by Health Level Seven International (HL7), is a standard for exchanging healthcare information electronically. It is designed to be simple, flexible, and easy to implement, using modern web technologies and standards. The Patient Access API, mandated by the Centers for Medicare & Medicaid Services (CMS) Interoperability and Patient Access final rule, is intended to provide patients with easy access to their health information through third-party applications using FHIR.

Reasons for Low Utilization of the Patient Access API

Before delving into the reasons for investing in FHIR, it's essential to understand why the Patient Access API has seen limited use:

1?? Lack of Awareness: Many patients are unaware of the availability and benefits of the Patient Access API. Without sufficient education and promotion, utilization remains low.

2?? Technical Barriers: Integrating and using the API requires technical expertise and resources that some healthcare providers and payers may lack.

3?? Privacy and Security Concerns: Patients and providers may have concerns about data privacy and security, deterring them from using the API.

4?? Market Maturity: The ecosystem of third-party applications leveraging the API is still developing, limiting the immediate utility for patients.

Strategic Reasons for Investing in FHIR

Despite these challenges, health payers should consider several compelling reasons to invest in FHIR:

1. Future-Proofing Healthcare Operations

FHIR is rapidly becoming the global standard for healthcare data exchange. By investing in FHIR now, health payers can ensure they are prepared for future regulatory requirements and technological advancements. This proactive approach can prevent costly last-minute compliance efforts and position payers as leaders in the evolving healthcare landscape.

2. Enhancing Interoperability

One of the primary goals of FHIR is to enhance interoperability between different healthcare systems. By adopting FHIR, health payers can facilitate seamless data exchange with providers, patients, and other stakeholders. Improved interoperability can lead to better care coordination, reduced administrative burdens, and enhanced patient outcomes.

3. Improving Patient Engagement

Although the Patient Access API has seen low utilization, the broader goal of patient engagement remains critical. FHIR can enable innovative applications that empower patients to take control of their health data. As awareness and demand grow, health payers with established FHIR capabilities will be well-positioned to meet patient needs and preferences.

4. Driving Innovation

FHIR's flexible and modern framework encourages the development of innovative solutions in healthcare. By investing in FHIR, health payers can support and benefit from new applications and services that improve care delivery, patient experience, and operational efficiency. This innovation can drive competitive advantage and open new revenue streams.

5. Enhancing Data Analytics and Decision-Making

FHIR facilitates access to comprehensive and standardized healthcare data, which is crucial for advanced analytics. Health payers can leverage this data to gain insights into patient populations, optimize care management programs, and make informed decisions. Enhanced analytics capabilities can lead to cost savings, improved health outcomes, and better resource allocation.

6. Regulatory Compliance

As regulatory bodies continue to emphasize interoperability and patient access to health data, compliance with FHIR-based standards will become increasingly important. Health payers investing in FHIR now can ensure they meet current and future regulatory requirements, avoiding potential penalties and ensuring smooth operations.

7. Enhancing Provider Collaboration

Effective collaboration between payers and providers is essential for value-based care models. FHIR enables more efficient data sharing, reducing administrative overhead and fostering stronger partnerships. This collaboration can lead to better patient care, improved provider satisfaction, and more effective care management strategies.

Overcoming Challenges

While the benefits of investing in FHIR are clear, health payers must address several challenges to maximize their return on investment:

??? Education and Training: Investing in education and training for staff and stakeholders is crucial to ensure effective implementation and utilization of FHIR-based systems.

??? Security and Privacy: Implementing robust security measures and educating patients about data privacy can mitigate concerns and build trust in FHIR-enabled applications.

??? Collaboration with Vendors: Partnering with technology vendors and developers can help health payers overcome technical barriers and accelerate the adoption of FHIR-based solutions.

Conclusion

The low utilization of the Patient Access API should not deter health payers from investing in FHIR. The strategic advantages of FHIR, from enhancing interoperability and patient engagement to driving innovation and regulatory compliance, far outweigh the initial challenges. By investing in FHIR, health payers can future-proof their operations, improve patient outcomes, and position themselves as leaders in the digital transformation of healthcare.

For more on learning about implementing all the CMS 0057 Requirements on an Optimal Performing Interoperability Platform please contact Naveen Chaudhary, PMP or Mark Scrimshire at Onyx .?

About Onyx ??

Onyx Technology, LLC is a healthcare managed interoperability compliance solutions provider. Onyx emerged from work with CMS in establishing the nation’s first nationwide FHIR-based API, Blue Button 2.0. Building on this experience and expertise, Onyx has partnered with Microsoft to build the industry’s leading platform for FHIR-based interoperable exchange. Focused on standards-based, interoperable technologies that ensure security, privacy and the delivery of the right information to the right place at the right time, Onyx is the expert in enabling our customers to garner the greatest value from their participation in the healthcare eco-system of tomorrow.??Please visit us at www.onyxhealth.io .?