Adopting FHIR to Reduce Costs, Improve Consumer Experience

Joe Gagnon, CEO, 1upHealth, reviews how fast health care interoperability resources (FHIR) can aid organizations in improving data collection, care quality, and the consumer experience.

Read the full transcript:

Welcome back to PopHealth Perspectives, a conversation with the Population Health Learning Network where we combine expert commentary and exclusive insight into key issues in population health management and more.

In this episode, Joe Gagnon offers insight into how FHIR can improve health care costs and the consumer experience.

Hi, my name is Joe Gagnon. I'm the CEO at 1upHealth. My passion for how data can help us live better makes it fun to drive a company that's going to help do that across the health industry.

How are interoperability requirements changing the way health care organizations approach data?

The most interesting part about this idea of interoperability is that when interoperability works, no one notices. We know that what we need to do is to be able to connect systems, people, and processes with a common language. Most health data systems in the past have been proprietary, so there wasn't an easy way to connect.

What that does is limit our effectiveness. It limits the way data gets represented and used. So there has been a really big push across the industry to say that we can no longer be proprietary with suboptimizing on risk, quality, care, and cost, and the way to solve that problem is data interoperability.

Other industries have used data interoperability as a life changer, and we all experience it day to day. We're ready for that in health care now.

Have current regulations been successful in making interoperability a priority?

Often, we ourselves are not capable of initiating change. So in this instance, we needed the government to say, "We're going to use a FHIR data standard."

When the government said we needed to follow the FHIR standard, they had to do it where they had some leverage—in the area of Medicare and Medicaid reimbursement. For those patients, the first step was for CMS to tell the payer community to use FHIR to represent the data, so patient access could happen to FHIR data resource. It was a push toward taking care of yourself—eating your broccoli, so to speak—for the industry. The government used this standard where they had control to start us on the path of improvement.

What is FHIR and how is it used?

FHIR is an evolved data standard. It's a way to describe data using a restful API that allows you to use standards from the internet to be able to communicate.

When you are using your browser, for example, and you are typing in the search bar, it's creating a language, a representation of the data and functionality that you need. If you were to place an order with Amazon, when it gets to Amazon, it knows exactly what you wanted.

It's the same idea in health care. We're going to have this language that's evolved from other standards and gets to a resource-level identification. One of the constraints of medical records is they are fixed documents, which only represented what was there and could show it to us in only one way. With FHIR, we're able to create dynamic resources that represent the use case of a payer, provider, or pharma to the functionality they need.

FHIR is a standard that the industry understands. It's documented by CMS and it's now being used minimally in the payer community, and now more broadly in the provider community as well.

How does FHIR impact the consumer experience?

Long term, FHIR will definitely affect the consumer experience. Today, probably not a lot. We don't really notice. Many of us don't even know that we could make a data request to our insurance carrier to get a copy of our claim through a user interface.

I think what we'll see over time is that everything you've gotten used to, with an app to serve your banking, retail, or living needs, will happen in health care. FHIR will enable that.

Imagine you went to your primary care physician in the future, and they said, "Hey, you should go see a GI doctor." You know how hard that is to get a referral, get an appointment, get your medical records, go to the actual appointment, and have the follow up. All of that would happen seamlessly.

You would leave, and the next thing you'd know, you'd have a message on your phone that has an appointment scheduled, fit to your calendar; your medical record was electronically transferred there; you showed up, and you didn't have to fill out any forms; you had the test done in your primary care provider. You would have almost no role to play, other than having that colonoscopy done. Whereas today, we sit in a waiting room, filling out forms, on hold, trying to get an appointment.

The consumer experience will markedly change in the future. Right now, it's a lot simpler than that, but we know there's a lot in the future for us.

Is there anything else you wanted to say about FHIR in the future and how it's going to impact interoperability?

At 1upHealth, we're excited because we're basically a new entrant. We could be a disruptor. We can think more broadly about how the industry should operate.

This is a $4 trillion industry that's not operating at its best today. Four of 5 patients don't feel they get good service at some level, whether it is care quality or cost.

As you start to put data into the experience, you're going to have this opportunity to gain insight and provide better access. Costs should go down, choice should go up, risks should go down. What we’re hoping is that the industry—not just because the government said you should do this—realizes that it's time to improve.

It's time to re-engineer and move into the modern era. I don't feel that health data is modernized, yet, the way it needs to be. That's what we're going to see over the next 3 to 5 years.

If we could fast forward 10 years from now, we'll start to live longer, happier lives as the result of having better data that is more timely, accurate, clean, quality, and comprehensive than we would otherwise have. And that'll be really meaningful for all of us.

Thank you, Joe. That's about it for my questions. Do you have anything else you would like to add?

All of us, as patients and consumers, should ask the providers, payers, and pharma to push this to happen faster because it'll benefit all of us. Don't accept the average solutions we have today. Demand more, and life will get better, and we'll be all better for it.

Thanks for tuning in to another episode of PopHealth Perspectives. For similar content or to join our mailing list, visit populationhealthnet.com.

This transcript has been edited for clarity.