With the CMS and ONC March 2020 endorsement of HL7 FHIR R4, FHIR is positioned to grow from a niche application programming interface (API) standard to a common API framework. With broader adoption, FHIR promises to support expanding healthcare interoperability and prepare the industry for complex use cases by addressing significant challenges: Engaging consumers. Sharing data with modern standards. Building a solid foundation for healthcare interoperability.

1. Interoperability in Healthcare:
Making the Most of FHIR
Brian Eliason
Kevin Sigafoes

2. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Interoperability in Healthcare
The March 2020 endorsement of HL7®
FHIR® R4 by both the CMS and ONC
final rules may be the impetus for FHIR to
move from a niche application program-
ing interface (API) standard to a common
API framework.
While FHIR is already showing promise
to grow healthcare interoperability, its real
value will come when utilization moves
beyond a handful of workgroups, EMR
suppliers, and niche vendors.

3. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Improving Interoperability in Healthcare:
Potential FHIR Use Cases
While healthcare waits for an industry-
defined data model that’s pragmatic for
business-critical analytics and outcomes
improvement, FHIR is emerging as a
capable candidate, driving the healthcare
information exchange industry to consider
how their platforms align with FHIR.

4. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Improving Interoperability in Healthcare:
Potential FHIR Use Cases
The potential FHIR use cases in Table 1, below, underscore the following
significant interoperability themes moving through the industry, which the
CMS and ONC final rules reinforce:
Consumer engagement
occurs through the
technologies they use,
with relevant data and
simplified access.
Data is useful, but data
sharing with modern
standards will create
innovations for consumers,
providers, and payers.
FHIR does not solve
all healthcare IT
interoperability needs,
but it provides a
solid foundation.

5. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Improving Interoperability in Healthcare:
Potential FHIR Use Cases
INNOVATION
API Development
INTEGRATION
Simplified Workflows
STANDARDIZATION
Regulatory Compliance
Data Acquisition
Population-Based Query
Batch Load
Workflow Integration
Closed Loop (Results)
Embedded Apps
Notifications and Alerts
Quality Measure (QM) Reporting
HEDIS/STARS
Library of QMs
Custom
Consumer Applications
PHRs
Mobile Apps
Patient Access API (Payers)
Analytic Output
SDOH Risk Assessment
LACE Score
Gaps in Care
Patient Registries
Supplemental Clinical Data for Quality
Measures
Systems Integrations (M&A, Partner,
Client System)
Care Coordination Support
Transition of Care
Referrals
Community Data Sharing
Decision Support
Chart Review Automation
CMS Audit
Coding and Billing
Compliance
Provider Directory API
Payer-to-Payer Data Exchange
Prior Authorization
Specialty Pharmacy
(Automation)
CMS and ONC Final Rules
Open API
Data Sharing
Pricing Transparency
Table 1: Potential FHIR Use Cases

6. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Understanding FHIR Customers Adoption
Needs and Priorities
Many organizations will have a FHIR
service implemented to meet the
federal requirements and succeed in
using FHIR to achieve improvements.
Complex use cases will require more
data from more sources, and FHIR will
require not only a broad adoption but a
culture of data sharing and outreach to
new customers.

7. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Understanding FHIR Customers Adoption
Needs and Priorities
Figure 1 illustrates an adoption
model in which organizations
assume a few complex, high-value
FHIR use cases early.
Point-to-point projects should
expand quickly and simplify
processes, such as data acquisition
and publishing data from an EMR.
Expanding beyond an organiz-
ation’s IT ecosystem requires that
data trading partners have a
comparable readiness level.
Figure 1: The FHIR maturity process.

8. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Understanding FHIR Customers Adoption
Needs and Priorities
For example, an organization can do
great things with FHIR and its acute
EMR by embedding applications or data
into provider workflows.
The EMR approach should succeed,
but for a broader provider community
in which the EMR mix is diverse, it will
require scaling the FHIR solution and
the supporting services.

9. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Understanding FHIR Customers Adoption
Needs and Priorities
Achieving and sustaining data-driven
healthcare improvements with FHIR
relies heavily on the technical readiness
of the vendor and partner systems, as
the vendor community is a partner in
this FHIR ecosystem.
Acquiring the technology and team
member skills to implement and
maintain the FHIR solution could be
a multiyear effort.

10. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Understanding FHIR Customers Adoption
Needs and Priorities
Understanding the readiness of data
trading partners will allow organizations to
select use cases with the highest likelihood
of success, grow expertise, and prepare for
the more complex use cases.

11. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Selecting a FHIR Pathway
When selecting a FHIR pathway, a few simple questions inform the strategy:
Who Are the End Users,
and How Ready Are They?
Do I have the Data
Necessary to Succeed in
FHIR Adoption?
What Are the FHIR
Implementation Models,
and Why Do They Matter?

12. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Selecting a FHIR Pathway
Do I have the Data
Necessary to Succeed
in FHIR Adoption?
The United States Core Data for Interoperability
(USCDI) standards, a foundation for broader sharing of
electronic health information to support patient care,
should be the minimum data set.
When an organization expands into more complex use
cases, additional data and systems contributing to the
FHIR strategy grow.
Organizations that target the consumer with their FHIR
strategy will need to consider how consumer-generated
data fits into the organization’s data strategy.
Entities that grow through mergers and acquisitions will
need to understand how to include the additional data
sets, likely from a different EMR, in the FHIR strategy
as well.

13. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Selecting a FHIR Pathway
Who Are the End
Users, and How
Ready Are They?
EMR users will be the early FHIR adopters, as the
EMR vendor community is offering an increasingly
robust FHIR service.
Even organizations tackling the less complicated use
cases, such as closed-loop or embedding applications,
can quickly hit the limits of their own systems.
Expanding the FHIR solution beyond the EMR requires
more effort and understanding around the technology
capabilities, the workflow impacts of new partners, and
the talent needed to implement and maintain a growing
list of API connections.

14. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Selecting a FHIR Pathway
What Are the FHIR
Implementation Models,
and Why Do They Matter?
Critical to those leading their organization’s FHIR
initiative is understanding which use cases to
implement and whether they have the resources to
maintain and scale as FHIR adoption matures.
The FHIR implementation strategy is critical to
success.
Figure 2 illustrates three common FHIR
implementation architectures—loose, hooks, and deep.

15. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Selecting a FHIR Pathway
Column 1: Loose Integration, Focused Scope
If the organization has specific use cases to
adopt and has just begun assessing its long-
term FHIR strategy, it might look at a solution
architected similar to column 1.
In this model, team members will learn more
about the technology along the way, inform
their strategy with experience, and limit the
risk and investment until they have defined
the strategy and have some expertise.

16. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Selecting a FHIR Pathway
Column 2: Mild (Hooks) Integration, Broad Scope
If an organization has a strategy, resources
(both internal and external), and the desire to
use FHIR in the platform-as-a-service (PaaS)
model (e.g., Amazon Web Services or MS
Azure), it will have greater flexibility to
determine which use cases to support.
The model in column 2 provides managed
FHIR services that allow the organization to
focus on the use cases and customers, not
the technology.

17. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Selecting a FHIR Pathway
Column 3: Deep Integration, Broad Scope
Investment in a FHIR-enabled platform
modeled in column 3 (e.g., an EMR, EDW,
or a cloud-based data platform) will provide
additional advantages, particularly in
governance and limiting replication of data
for FHIR.
FHIR would be one of many capabilities of the
data platform, deeply integrated with other
services such as a master patient index,
terminology services, telemetry, and other
platform management services.

18. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
The Right Strategy Readies Organizations
for the Potential of FHIR
The healthcare industry stands to benefit
by adopting the FHIR API.
Federal compliance pressures may
cause some short-term challenges, but
organizations can ready themselves
with an adoption strategy that looks
beyond the initial push for compliance
and accommodates complex use
cases that require more partners, more
connections, and likely more time.

19. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

20. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
More about this topic
Link to original article for a more in-depth discussion.
Interoperability in Healthcare: Making the Most of FHIR
Continuity of Care Documents: Today’s Top Solution for Healthcare Interoperability Demands
Adam Bell, Director of Clinical Advisory and Provider Outreach Services;
Kristen McRae, Senior Product Management Professional
The Biggest Barriers to Healthcare Interoperability
Dan Soule, VP Product Management
Agnostic Analytics Solutions vs. EHRs: Six Reasons EHRs Can’t Deliver True Healthcare Interoperability
Mark McCourt, Senior VP, Sales; Mike Noke, MBA, Senior Regional Account Executive;
Neil Andersen, Senior Account Executive; Ryan Smith, MBA, Senior VP and Executive Advisor
Interoperability in Healthcare Data: A Life-Saving Advantage
Greg Miller, VP, Sales
Pairing HIE Data with an Analytics Platform: Four Key Improvement Categories
Adam Bell, Director of Clinical Advisory and Provider Outreach Services; Carol Owen, SVP, Interoperability
Dan Soule, VP, Product Management; Eric Crawford, Head of Product - Interoperability, Analytics and Big Data

21. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Brian Eliason brings more than 10 years of Healthcare IT experience to Health
Catalyst, specializing in data warehousing and data architecture. His work has been
presented at HDWA and AMIA. Prior to coming to Health Catalyst, Mr. Eliason was
the technical lead at The Children's Hospital at Denver with experience using I2B2.
Previously, he was a senior data architect for Intermountain Healthcare, working
closely with the disease management and care management groups. Additionally, he
helped Intermountain bridge clinical programs with the payer-arm, Select Health. Mr.
Eliason holds an MS in business information systems from Utah State University and
a BS from Utah Valley University.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Brian Eliason, MIS

22. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Kevin is an accomplished HIT Leader with over 15 years of experience in
developing, implementing, and sustaining software in the healthcare information
technology industry. He thrives on working with high-performing teams, and
currently is focused on bringing innovative solutions to advance interoperability
and data portability for the Health Catalyst cloud-based Data Operating System.
Kevin is a big fan of the 21st Century Cures Act and the impact on Open API's, and
driving engagement between the Consumer, Providers, and Payers.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Kevin Sigafoes

23. © 2020 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Health Catalyst is a mission-driven data warehousing, analytics and outcomes-improvement
company that helps healthcare organizations of all sizes improve clinical, financial, and operational
outcomes needed to improve population health and accountable care. Our proven enterprise data
warehouse (EDW) and analytics platform helps improve quality, add efficiency and lower costs in
support of more than 65 million patients for organizations ranging from the largest US health system
to forward-thinking physician practices.
Health Catalyst was recently named as the leader in the enterprise healthcare BI market in
improvement by KLAS, and has received numerous best-place-to work awards including Modern
Healthcare in 2013, 2014, and 2015, as well as other recognitions such as “Best Place to work for
Millenials, and a “Best Perks for Women.”