May 23, 2022
HL7 FHIR Connectathons are an important way for the industry to share ideas and test out workflows related to FHIR. These connectathons happen three times a year, and at the 30th
edition of HL7 FHIR Connectathon in May, Infor participated in multiple tracks related to CMS mandated workflows. In particular, Infor leveraged its FHIR Bridge product to participate in the track for FHIR Notifications
which is an HL7 Da Vinci Use Case.
In May, 2021, requirements started for hospitals to send admission, discharge, and transfer notifications to other providers. This was part of the Interoperability and Patient Access Final Rule (CMS-9115-F). While the rule did not mandate HL7 FHIR be used for this workflow, nonetheless there are clear advantages to using FHIR. The ONC in their Interoperability Standards Advisory (ISA) Reference Edition, lists FHIR Notifications as an implementation specification for this purpose. However, the document notes that the FHIR adoption level for this workflow is low, while legacy HL7 v2 ADT’s are what has been widely adopted to fulfill this requirement.
In general, notifications communicate real-time information for patient care, value-based care, and risk-based services. Clinicians can provide proactive patient care when notified of activities that occur in a patient’s care journey. With regards to the CMS mandate, only events related to admit, discharge, and transfer must be communicated. However, the breadth of notifications has the potential to go much deeper, such as notifications about changes in treatment, a new medication, or a new diagnosis, just to mention a few. These notifications can provide updates to care professionals that could be critical in improving care management, care coordination, quality programs, and others. With richer and more expedient data being shared, actions can be taken to intervene earlier for better patient care at a reduced cost.
Another aspect of notifications is not only to send unsolicited notifications, but to allow clinicians to subscribe to the data that would be important for them based on their responsibility in the chain of care. Subscriptions allow clinicians to get data on very granular events which closely align with their efforts to provide targeted care. Utilizing the FHIR Subscription resource, in addition to unsolicited notifications, givens clinician control to subscribe to the care information they deem critical about the patient.
Merging Old with the New, Implementation Flexibility
At the FHIR Connectathon, Infor was able to accept a FHIR Notification Bundle from a trading partner, validate it against the FHIR specification, and place the individual FHIR resources into Infor FHIR Server for later retrieval. As the industry progresses from HL7 v2 to FHIR, flexibility in implementing FHIR notifications with legacy systems will be critical. Infor FHIR Bridge can accommodate this required flexibility in a variety of ways, including:
- Receiving a FHIR Notification Bundle, and
- Placing it in a FHIR server as a bundle for future retrieval
- Placing it in a FHIR server as individual resources for future retrieval
- Placing it in a FHIR server as individual resources to trigger subscription notifications
- Forwarding it to a legacy system as an HL7 v2 message
- Validating the message bundle against the FHIR specification
- Creating a FHIR Notification Bundle from
- An HL7 v2 message generated by a legacy system
- An HL7 CDA document used for transition of care
- A FHIR server based on a subscription
A Challenge to Evolve
As the deadline to meet the notification requirement in 2021 loomed, it was common for providers to put in place the solution that could most easily meet the requirement. In most cases, that solution was to leverage HL7 v2 messages that are commonly used by legacy systems today. But now that the deadline has gone and passed, it might be time to re-evaluate how the robustness of FHIR Notifications might be utilized to provide a richer and more pointed exchange of data among clinicians. As stated above, FHIR has the ability to exchange data in a much more targeted way than legacy systems allow, leading to more proactive care and better quality. Is the industry ready to embrace FHIR for these workflows?