Interoperability standards: FHIR, direct, and cloud fax

By | March 7, 2020

One thing is not in doubt: everyone would benefit from improved interoperability of healthcare data. Providers strive to take back their day by streamlining referrals, prior authorizations, and patient queries, many still done by phone or fax.

The method by which interoperability should occur is by no means as clear. None of the proposed standards for healthcare data exchange has emerged as a definitive leader, leading HHS to press the issue by demanding at the beginning of 2019 that Medicaid providers give enrollees immediate electronic access to medical claims and other health information electronically by 2020.

The Direct standard, FHIR, and cloud fax are the three top contenders for eliminating paper-based information sharing in healthcare. As you might expect, each has strong use cases and challenges. Below is a brief summary of each, with greater detail provided in the article “Exchanging Data: Three Standards Compete to Provide Interoperability.” 

  1. Direct. This email-based standard relies on Health Internet Service Providers (HISPs) to maintain secure servers and carry out the encryption/decryption and digital signing of each message containing protected health information. Use cases include bidirectional referrals and automated patient summaries for ED visits; obstacles include a lack of education about the technology, costs, and technical difficulties associated with certain types of messages.
  2. FHIR. Much-touted in the mainstream press, Fast Healthcare Interoperability Resources was developed by HL7 to support a multitude of transfer mechanisms, including HTTP-based transfer and the HL7 minimal lower layer protocol (MLLP). Use cases include aggregating data into a personal health record and document sharing via a federated system of repositories; obstacles include confusion over FHIR version and vendor’s need to stay updated.
  3. Cloud fax. An overwhelming percentage of medical data exchange still occurs via traditional fax. An improved form of this communication is emerging as a possible successor. Unlike the less-than-secure nature of the physical fax, cloud fax services send highly secure email messages with attachment to other fax services, both digital and physical. Use cases include referrals, care transition materials, and prior authorizations; obstacles include confusion with traditional faxing and government efforts to eliminate fax as a mode of health data exchange.

Widespread interoperability is critical for patients as they seek the data they need to advance their own healthcare and for providers endeavoring to make the best possible clinical decisions for their patients. The good news is that interoperability solutions from leading vendors are beginning to combine these technologies, giving providers access to platforms such as CommonWell and Carequality, plus connections to ACOs and HIE data, all while giving patients a way to easily find all their data in one location.

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