Despite the data explosion in the past 10-15 years, this has largely been “data unrealized” – its value has not been exploited. Subsequent investments in Data integration strategies, Technology, and analytics have transformed a medley of free-floating data points into an integrated, coherent message. Pharma has leveraged Data integration across the value chain, from discovery through development to commercialization. Healthcare is also leveraging data integration strategies to drive value-based healthcare models.The integration of this data has created the opportunity to delve deep into the real world and generate meaningful insights, optimize patient recruitment, develop a better understanding of various therapeutics, and directly improve patient outcomes.
Healthcare is evolving from a fee-for service (FFS) model to a “patient-centric”, data-driven ‘value-based’ healthcare model and this transition will only be possible through the effective integration of multiple data sources to assess patient outcomes, measure performance improvements, and correlate cost control measures (Horner B et al, 2019).Interoperability would significantly ease the data integration process.Fast Healthcare Interoperability Resources(FHIR) is an open healthcare data exchange and information modeling standard created by Health Level Seven, an international health-care standards organization. It provides data formats and elements and an application programming interface (API) to drive Interoperability within our highly fragmented healthcare ecosystem. Not only has interoperability been limited owing to the disparate systems that exist, but also because some players have built barriers to data sharing. To surmount this, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator of Health IT proposed a rule in 2019 to prevent information blocking to enable patients to access their electronic health information (Terry, 2019). FHIR’s Internet-based approach, called Substitutable Medical Applications and Reusable Technologies (SMART)on FHIR, utilizes web standards that allow developers to adopt a standard set of app models that would work across the different health IT systems.
Data integration has been driven by various FHIR initiatives involving key stakeholders, such as the payer-focusedDa Vinci Project, and the provider-centered Argonaut initiative. Technology initiatives include Certified EHR Technology (CEHRT) andSMART APPhave been launched. CEHRT, which became effective in 2019,provides an assurance that an EHR system offers the necessary technological capability, functionality, and security to help them meet the meaningful use criteria. To avoid a downward payment adjustment, health care providers are required to use the 2015 Edition CEHRT (Bresnick, 2018, CMS.gov). The SMART APP Launch provides a frameworkthat connects third-party applications to EHRs. However, despite these initiatives, industry challenges still do exist in terms of integration with legacy approaches and shifting from transaction-oriented standards to FHIR-based interaction-oriented standards (Heath, 2016).Medicare’s Blue Button 2.0 leverages FHIR-based APIs which allow subjects to download their personal health data directly from CMS and share it with providers or retain it for their own records. End-users such asdevelopers, providers, and researchers can also mine that data and generate actionable insights from the same at no cost and the sandbox has been created in such a way that the data cannot be traced back to patients (Bresnick, 2018).
Getting the right medicine to the right person at the right time and place requires the ability to pool multiple data sources and derive meaningful insights.
