MyLinks on FHIR
However, the introduction of FHIR (Fast Healthcare Interoperability Resources, pronounced "fire") has the potential to revolutionize healthcare interoperability. FHIR has not only improved the exchange of data among EHRs, but it has provided the ability for patients to gather their electronic records from EHR systems.
FHIR was first published in 2011, and has since undergone several revisions, with the latest version being FHIR R4. It has been widely adopted and is supported by major EHR vendors, government agencies, research organizations, and other healthcare organizations worldwide. It's also being used by many health-related industries like medical devices, wearables and health apps. As of December 31, 2022, all certified EHRs are required to provide patients access to their data via consumer applications that use the FHIR standard (more about the government mandates below).
What are the Benefits of FHIR?
Benefits to healthcare providers:
With FHIR, healthcare providers have access to more complete and accurate patient information, leading to better diagnoses and treatment plans. Additionally, FHIR can help reduce the number of duplicative tests and procedures, which can save time and money for patients and providers.
Benefits to public health:
Another benefit of FHIR is its ability to improve population health. With FHIR, public health officials have better access to more standardized, complete, and accurate information about the health of populations, which can help identify and address health disparities. This can lead to better-informed public health policies and interventions.
Benefits to research organizations:
With FHIR, patients can now share their health data directly with researchers in a standard format. Researchers can also have a standard data structure from EHRs to study large populations. Hopefully, this will lead to faster cures and improved outcomes for millions of patients.
Benefits to patients and their caregivers:
- Empowerment: By having access to their health data, patients can better understand their health status, make more informed decisions about their care, and take a more active role in managing their health.
- Improved Quality of Care: Patients can share their data with multiple providers, and this in turn can help providers to make more accurate and complete diagnoses and treatment plans. This is especially important during emergencies when timely access to health data is critical.
- Better Coordination of Care: Patients can share their data with multiple providers, which helps to improve care coordination and continuity across different providers, especially for patients with complex medical conditions.
- Increased Safety: Patients can access their data through FHIR apps, which can help to identify and prevent errors and improve the safety of their care.
- Cost Savings: By giving patients access to their data, they can make better-informed decisions about their care, which can help to reduce healthcare costs.
- Research: By allowing patients to share their data with researchers, it can help to accelerate medical discoveries and improve the development of new treatments and therapies.
How does MyLinks use FHIR?
How is the MyLinks FHIR application different from a clinic’s portal?
- The data in a portal is owned by the health system. The portal data is a partial view into their system. You cannot add, delete, or edit the data.
- If the health system changes their EHR or portal, your previous health data will likely be unavailable electronically.
- Portals do not contain data from all your health systems. It is a fractured view of your health data. MyLinks provides you with a full view of all your data imported into your own record.
- Data in a portal is often limited to whatever the health system wants to share. Government mandates require many more items to be shared with FHIR applications than are usually available in a portal.
- Many portals do not share data immediately and may not share information for many days after it is available in the EHR. Government mandates require health organizations to give FHIR applications access to data immediately after it is entered into the EHR.
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What is MyLinks' role in the development, maturity, and use of the FHIR standard?
MyLinks was one of the first consumer facing FHIR applications and won first place in a government contest for the best Consumer Health Data Aggregator.
FHIR continues to mature through HL7 workgroups who develop use cases where FHIR could benefit healthcare. These use cases are then tested at connectathons where engineers use the FHIR standards to share data among disparate systems. Once the FHIR resources have gone through vigorous testing, an implementation guide is developed so it can be used throughout the healthcare industry. The MyLinks team has been engaged in all these processes for many years.
2011 - Initial draft of FHIR as a blog
Grahame Grieve started writing the first version of Resources for Health, which would later be known as "FHIR".
2014 - Initial HL7 Release of FHIR
DSTU1 (First Draft Standard for Trial Use) was released.
2014 - October - Industry Report
Industry report known as JASON Task Force recommended the adoption of newer standards for data exchange. FHIR was a good fit per this recommendation.
2016 - ONC launches the Consumer Health Data Aggregator Challenge
The ONC launches the Consumer Health Data Aggregator Challenge to spur development of consumer-facing FHIR applications to help consumers aggregate their data in one place and under their control.
2017 - MyLinks wins First Place in the Consumer Health Data Aggregator Challenge
We were thrilled!
2018 - Da Vinci Project Started
A group of Health Plans, Providers, and EHRs came together to form the Da Vinci Project. This group focuses on solving interoperability issues using FHIR.
2018 - May - MyLinks goes live
MyLinks goes live to the public as health systems begin to implement the "FHIR API".
2019 - Release 4 Normitive for Select Resources
FHIR matured into its 4th version, known as FHIR R4 and gets cited in federal regulations.
2019 - HL7 Vulcan Accelerator Created
HL7 Vulcan Accelerator was started to bring together stakeholders to develop and mature FHIR resources for research use.
2019 - March - Final Rule by ONC/CMS
The ONC (Office of the National Coordinator) and the CMS (Centers for Medicare & Medicaid Services) finalized the rules as part of the Cures Act, that included FHIR as a requirement.
2021 - July - Health Plan Members Can Access Clinical and Claims via FHIR
Per the Cures Act Final Rule, patients can now access their clinical and claims data from payers like insurance companies via FHIR.
2021 - Helios Accelerator Started
Helios Accelerator was started to streamline data sharing across all levels of public health using FHIR.
2022 - December - G10 Certified EHRs Must Make FHIR R4 Available to Practices
As of December 2022, EHRs began rolling out FHIR R4 to their practices.
What is the ONC FHIR Mandate?
In the United States, the 21st Century Cures Act, passed in 2016, includes provisions that encourage the use of FHIR and other standards for exchanging healthcare information. The ONC’s Cures Act Final Rule requires healthcare providers and payers to make certain types of patient data available through an API (Application Programming Interface) that conforms to the FHIR standard by December 31, 2022.
Additionally, the mandate requires API Technology Suppliers to support the publication of service base URLs for all of its customers, and make such information publicly available, in a computable format, at no charge. This statement in the Cures Act, means EHRs and companies that manage FHIR for healthcare providers must publish a list of service base URLs, also known as "FHIR URLs" or "endpoints". FHIR developers can then use this information to setup and use a FHIR endpoint.
Not complying to this mandate may result in an “Information Blocking” claim against an EHR vendor, health care provider, or payer resulting in up to a $1 million penalty per violation. This mandate is intended to make it easier for patients to access their own healthcare information and to share it with other healthcare providers as needed.
What are "FHIR Resources"?
- Smoking Status
- Clinical Notes
- Care Team Members
- Patient Demographics
- Unique Device Identifiers
- Vital Signs
- Health Concerns
- Assessment & Plan of Treatment
The elements of USCDI have been maturing and increasing over time. As of January 17, 2023, the ONC was working on USCDI V4. These advances occur as the FHIR technology matures and as more uses for the FHIR standard are found. USCDI v1 shown below.