The importance of FHIR in closing medication data visibility gaps

If you have ever baked a cake from scratch, you can appreciate the value of a well-documented recipe.

Consider how your cake might turn out if your recipe is incomplete and missing key details such as the number of eggs or the amount of sugar. While mixing your ingredients, you might have to stop and search to figure out what’s missing. Or, you might have to make an educated guess and hope for the best.

Assumptions to fill in the blanks can lead to unexpected and unwanted results. Medication management is obviously far more complicated than baking, but sometimes prescribers are missing key ingredients that are necessary to ensure success. Before prescribing a patient new medication, a physician needs specific information, such as details on current medications or conditions that could interfere with a new therapy to make informed decisions. With access to a patient’s complete usable medication history, the physician minimizes the risk of an adverse reaction that leads to dire, or even life-threatening, consequences.

Interoperability facilitates safe, effective care
When providers have full access to their patients’ medical histories, they are better equipped to deliver safe and effective care – a key reason why the industry continues to push for interoperability between disparate clinical systems. While it remains a challenge, stakeholders recognize that sharing critical patient data can lead to better care, but organizations are still struggling to fix a variety of technological, institutional and cultural roadblocks.

As an industry, we are making progress in interoperability efforts, though too often our interoperability “solutions” fail to consider the information clinicians require for effective decision-making. For example, most organizations have the ability to transfer data from one siloed system to another, but frequently, the incoming data is not well-integrated with existing clinical workflows. An interface that sends test results from the lab system to the EHR is helpful, but if the data doesn’t automatically populate a patient’s longitudinal health record, the benefits are more limited.

Easier interoperability with FHIR
In response to the demand for increased interoperability, software vendors and healthcare organizations are pinning high hopes on the Fast Healthcare Interoperability Resource (FHIR) standard to exchange data between disparate systems. FHIR builds on previous Health Level Seven (HL7) international standards and makes it easier than ever to exchange data, regardless of the system. Software vendors increasingly are adopting FHIR to send and receive data that not only enhances clinical decision-making but also improves health outcomes.

For example, a growing number of organizations are creating apps using the FHIR standard, with more new and innovative applications becoming available on a regular basis. These apps support a wide variety of tasks, covering everything from predicting congestive heart failure and tracking diabetes care, to facilitating medication management and the coordination of care.

Healthcare organizations that want to extend the capabilities of their EHRs have embraced these apps – except when their EHR vendors do not fully support the connection. While many vendors are opening their systems to encourage the use of innovative applications, other vendors are limiting access to critical portions of the patient record. By restricting the exchange of clinical data, vendors may be unwittingly compromising patient safety.

Right information at the right place at the right time to the right care team members
Patient quality of care and safety are enhanced when the right care team members are able to access the right patient information at the right place at the right time. When prescribing a medication, for example, a physician needs the patient’s current and past medication history, including exact dosages and any allergies or adverse reactions. These details must be readily accessible within the prescriber’s regular workflow, both at the point of prescribing and during medication reconciliation.

Consider how better access to complete medication histories could help prescribers combat opioid abuse and reduce the risk of overdose and other adverse reactions. As New Jersey Governor and White House Opioid Task Force leader Chris Christie noted earlier this year, “an American dies every 19 minutes from an overdose of heroin or prescription opioids,” according to the Surgeon General.

By providing clinicians a full view of a patient’s complete medication record from all prescribers, physicians can more easily identify patterns that suggest a patient is doctor-shopping for opioid prescriptions; having a comprehensive medication history also facilitates a more accurate calculation of a patient’s morphine-equivalent dosing. With full access to medication histories, physicians are better equipped to save the lives of their patients and prevent an addiction from forming.

If a physician is using any sort of app (whether provided by their EHR or third-party vendor) to enhance EHR usability or certain clinical workflows, medication-related details must flow freely between the app and the EHR. The exchange of information has to be bi-directional, regardless of whether the data is entered from within the app or directly in the EHR. The risk of an adverse outcome, including opioid abuse or overdose, is far greater when a patient’s medication history is incomplete or has gaps – especially during care transitions – which is why it’s critical for EHR vendors to support the sending and receiving of relevant data to the medication sections of their systems.

A recipe for success
FHIR is gaining widespread acceptance as an industry standard for the exchange of medical information, and for good reason. Integration based on the FHIR specification is giving clinicians more opportunities to share data and leverage their existing systems to improve the delivery of care and the safety of patients.

Providers, vendors, and healthcare professionals must work together to make healthcare as safe, effective, and efficient as possible. With collaboration that includes open access to all sections of patient medical records, we can deliver clinicians the critical information they need to drive better patient outcomes, reduce avoidable readmissions and decrease costs.

Kunal Agarwal, vice president of product solutions, DrFirst

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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