SOLUTION PROVIDER Q&A
Innovation during the pandemic and beyond– the role of interoperability
How do you and your colleagues at Infor frame the concept of interoperability in this
moment in U.S. healthcare? Interoperability in healthcare has tradition- ally been between the four walls of the hos- pital–connecting specialty clinical systems to the electronic medical record (EMR). Infor Cloverleaf has expanded this concept also to connect the enterprise resource planning (ERP) software with the EMR. For example utilizing clinical information to predict sup- ply demand and adjust stock levels accord- ingly without requiring extra effort by care providers. But in recent years, the notion of interoperability has vastly expanded beyond the four walls of the hospital and now encompasses the entire care contin- uum. Nowadays, hospitals exchange data with outpatient care providers—from pri- mary care physicians (PCPs) and specialists to home healthcare agencies and post-acute providers. Also growing is the inclusion of Social Determinants of Health (SDoH) data, which include housing, nutrition, and other care needs based on the social demograph- ics of a patient, i.e., an elderly person living alone without family members to care for them after a hospital discharge. We also discuss with many customers their desire to create a “Digital Front Door” experience for patients that allows electronic access to services and data.
In this context we see the emergence of HL7 FHIR APIs to allow structured data interchange complementing the traditional healthcare centric HL7 v2 infrastructure, and our focus on the product develop- ment side is to create a seamless bridge between the existing HL7 v2 infrastructure and emerging FHIR based workflows with mobile and web-based front ends.
What are the main obstacles to achieving true interoperability, including semantic interoperability, in hospital and
health system operations? HL7 v2 is a great standard and the basis for hundreds of millions of transactions every week. However, it has its limitations
when it comes to semantic interoperability because it leaves room for great variabil- ity. This variability makes it difficult to aggregate data from different sources for modern use cases such as data analytics, risk stratification, and gaps-in-care detec- tion. HL7 FHIR is a more suitable stan- dard for these purposes because it more narrowly defines resource bundles and allows orchestrated workflows. The prob- lem therefore, really is to bridge between the production environments that transact vast amounts of transactions every day and FHIR, which enables higher quality levels of interoperability. Infor Cloverleaf developed products
such as FHIR Bridge, which creates bi- directional mappings in near real time, and Consolidator, which takes HL7 v2 and C-CDA input through FHIR Bridge and consolidates de-duplicated data around a patient for use by modern analytical applications. And with FHIR Server we can persist any FHIR objects, such as data from home-monitoring devices, and allow selective use of this data in the EMR either with a direct FHIR-to-FHIR or FHIR-to HL7 v2 transfer. We believe these are the tools healthcare organizations need to achieve the next level of interoperability.
Where are the key areas of opportunity for vendor partners to help their provider customers
reach interoperability? Healthcare organizations invested vast amounts of money, time, and effort to build the current HL7 v2 infrastructure. We believe as a vendor our role is to help both provider and payer customers lever- age their existing infrastructure—regard- less of vendor—and the data it gener- ates and transacts for the challenges and opportunities afforded by the transition to value-based care. That means we need to develop products and services that seam- lessly bridge between HL7 v2 and X11 on one side and FHIR on the other. As an example, we are actively involved in HL7 FHIR working groups such as DaVinci, Vulcan, and SANER. Each of these
Joerg Schwarz
Director, Strategy & Solutions – Healthcare Interoperability
Infor
working groups develop implementation guides for fast deployment of workflows, such as prior-authorization of payer- provider data exchange. Combined with our products that allow bridging between existing infrastructure and modern FHIR workflows, this will allow customers rapid deployment and greater ROIs.
What does the next few years
look like in this space? In our view, we see the coexistence of HL7 v2 and FHIR for many years to come. Yet, we also foresee many innovative work- flows around patient centric care, care transitions, care management, biomet- ric data monitoring, and automated, AI-assisted clinical decision support evolving as web services that will improve patient outcomes while simultaneously reducing overall healthcare costs and improving provider satisfaction.
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