Enabling Patient Access and Provider Directory API using Azure API for FHIR

Enabling Patient Access and Provider Directory APIs using Azure API for FHIR to meet CMS guidelines

by CMS FHIR ComplianceInteroperability

The final rule of the ONC’s Cures Act Final Rule is aimed for patients and healthcare providers to provide secure, seamless access and exchange of patient’s electronic health information. The rule also implies exceptions to blocking of information when it comes to patients accessing their electronic health record information (EHI). Centers for Medicare & Medicaid Services (CMS) has been working hard on improving the roadmap to improve interoperability and health information access for all stakeholders – patients, providers, and payers. 

One of the key rules released specific to interoperability is the Interoperability and Patient Access final rule (CMS-9115-F). This rule mandates the access and availability of the health information for patients whenever they need it. It also implies that patients must be able to use the information in the best way they can. The inability for seamless data exchange has deteriorated patient care, leading to poor health outcomes and increased medical costs.

The final rule that has been released includes key policies that impact different stakeholders. These policies focus on driving interoperability and delivering access to patient health data for health plans by liberating patient data using CMS authority to regulate Medicare Advantage (MA), Medicaid, CHIP, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs). The final rule ensures patients with better access to their health information, improves the interoperability and reduces burden on payers and providers.

Earlier this year, given the ongoing Covid-19 pandemic situation and recognizing the challenges faced by payers, CMS exercised enforcement discretion of the Patient Access and Provider Directory API policies for Medicare Advantage (MA), Medicaid, and the Children’s Health Insurance Program (CHIP) for a period of six months. The revised date of enforcement of these policies was set to July 1, 2021.

So, What’s Next post July 1, 2021?

It’s July 2021, and the Patient Access and Provider Directory API requirements from CMS are now effective. The rule requires the regulated payers to enable these new APIs with immediate effect. According to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), patients have the right to access their health information. It also requires the information to be exchanged in a way that ensures their privacy and security. The new CMS mandate to deliver Patient Access and Provider Directory API is a major breakthrough in the healthcare industry. This promotes the much needed interoperability of the patient’s medical data between payers and providers.

Patient Access API

According to the Interoperability and Patient Access final rule, all CMS-regulated payers are required to implement and maintain a secure and standards based API (HL7 FHIR API). Through this Health Level 7® (HL7) Fast Healthcare Interoperability Resources (FHIR®) API, patients shall be able to access their claims and encounter information easily. Patients can also choose to receive a subset of their medical information through authorized third-party applications of their choice. This information along with clinical data offer a broader perspective and understanding of the patient’s interaction with the healthcare system. This improves the overall decision making and leads to better health outcomes.

As your trusted partner, VNB Health can help to implement these new CMS requirements and better organize data within your organization. To successfully meet the CMS Patient Access rule for Health plans, we can assist to set-up your fully managed, enterprise-grade FHIR Server on Azure. The offering will be a HIPAA-compliant, platform as a service (PaaS) that can help to convert the clinical data such as claims, encounters and subsets of clinical data into FHIR supported format (FHIR Release 4.0.1 (R4)) using FHIR converters, set up third-party access management (e.g., OAuth 2.0) to ensure safe transmission of the data with the patients.

Azure API for FHIR has new REST API features and capabilities, and offers complete flexibility to businesses on what they can search in the system. The search can be performed using the common search parameters as well as resource-specific parameters and composite search parameters. VNB Health can help in implementing end-to-end solutions using Azure API for FHIR including integrations with specific apps, portals and analytics platforms.

Provider Directory API

The rule finalizes that CMS-regulated payers are regulated to make provider directory information publicly available via a standards-based API. This gives third-party application developers the advantage to access patient information. With this information, they can create services that help patients to find providers for care and treatment. On the other hand, it will also help clinicians find other providers for care coordination purposes. Overall, this aims to improve the quality, accuracy, and timeliness of information.

VNB Health’s experienced team can assist to build information of the providers using the FHIR based API in accordance with the HL7 FHIR 4.0.1 standards. This helps to retrieve provider names, address, phone number, specialty information, pharmacy information from publicly available sources. The API will keep a timely check on these data sources and will keep the data up-to-date. On top the API, our experts will assist in setting up a robust provider directory application. This will enable users to filter providers based on location and/or specialty, search for providers based on their location and office hours, filter specialists and their affiliations with local health practices, and identify a local health practice and their specialties seamlessly onto your application

Payer-to-Payer Data Exchange

The rule requires CMS-regulated payers to exchange patient clinical data (specifically the U.S. Core Data for Interoperability, USCDI, a spec on top of FHIR) on request from the patient. Patients can have this information handy when switching between payers to build a cumulative health record with the current payer. This requirement will take effect from January 2022.

VNB Health can assist your business to enable data exchange between payers. Our experts can easily implement this capability on top of the existing patient access API infrastructure and FHIR APIs. When the patient makes a data request, the payer can make this data available via the FHIR-based API in the form of electronic data and/or the format in which it was originally received.

Get started with FHIR on Microsoft Azure for Health today!

VNB Health has more than 15 years of proven experience working with healthcare organizations using Microsoft’s integration platform. Our experience with HL7 FHIR and Microsoft Azure technology enables us to build the technology to meet the CMS guidelines. As a trusted Microsoft Partner, we’ll work alongside your healthcare transformation journey to deliver improved data accessibility and patient care. Looking for a trusted partner to get started with your interoperability journey? Contact us today to embark on the healthcare transformation journey.

Microsoft Azure FHIR API - Health Data in the Cloud

Microsoft Azure FHIR API – Health Data in Cloud

by Interoperability

What is Microsoft Azure FHIR API?

Microsoft’s Azure API for FHIR is an offering to connect existing data sources like electronic health record systems and research databases. This solution is a long standing need for a simplified data management with a single, consistent solution for protected health information (PHI) in the cloud. This is an onset for new opportunities with analytics, machine learning and actionable intelligence across an Healthcare enterprise’s health data.

Microsoft Azure FHIR API allows rapid exchange data in the HL7 FHIR standard format with a single, simplified data management solution for protected health information (PHI). It brings together health data from disparate systems using industry standard HL7 FHIR. This robust, extensible data model standardizes semantics and data exchange so all systems using FHIR can work together.

microsoft azure fhir api drives better health outcomes

Microsoft Azure FHIR API helps relate points of data from across disparate systems to create richer datasets. Using these datasets we can enable advanced analytics scenarios that promote better health outcomes. Thereby we can connect people and health data in intelligent new ways across your infrastructure, productivity applications, business applications and analytics.

It allows to store your PHI data with confidence. Azure security isolates data and provides layered, in-depth defense and advanced threat protection that’s aligned to strict industry compliance standards. Azure covers more than 90 compliance certifications including ISO 27001 and meets HIPAA regulatory requirements.

microsoft azure fhir api active directory

The robust and extensible data model standardizes semantics and data exchange so all systems using FHIR can work together. Microsoft Azure FHIR API enables rapid exchange of data through Fast Healthcare Interoperability Resources (FHIR®) APIs, backed by a managed Platform-as-a Service (PaaS) offering in the cloud. It makes it easier for anyone working with health data to ingest, manage, and persist Protected Health Information PHI in the cloud.

Some of the detailed feature set of this service are as follows:

  • Managed FHIR service, provisioned in the cloud in minutes
  • Enterprise-grade, FHIR®-based endpoint in Azure for data access, and storage in FHIR® format
  • High performance, low latency
  • Secure management of Protected Health Data (PHI) in a compliant cloud environment
  • SMART on FHIR for mobile and web implementations
  • Control your own data at scale with Role-Based Access Control (RBAC)
  • Audit log tracking for access, creation, modification, and reads within each data store

Overall, it allows one to create and deploy a FHIR service in just minutes to leverage the elastic scale of the cloud. We pay only for the throughput and storage we need. The Azure services that power the Azure FHIR API are designed for rapid performance no matter what size datasets you are managing.

Microsoft takes care of the ease of operations of a FHIR Server which takes on the operations, maintenance, updates, and compliance requirements in the PaaS offering. This is an enabler to free an enterprise’s own operational and development resources.

At VNB Health, we did a deep dive into Azure FHIR API. Below is the service blade in Azure in our dev environment.

microsoft azure fhir api vnb built solution screenshot

Benefits and Highlights of Microsoft Azure FHIR API

Securely manage health data in the cloud

The Azure API for FHIR allows for the exchange of data via consistent, RESTful, FHIR APIs based on the HL7 FHIR specification. Backed by a managed PaaS offering in Azure, it also provides a scalable and secure environment for the management and storage of Protected Health Information (PHI) data in the native FHIR format.

Free up your resources to innovate

A health enterprise could invest resources building and running their own FHIR service. With the Azure API for FHIR, Microsoft takes on the workload of operations, maintenance, updates and compliance requirements. This allows you to free up your own operational and development resources.

Enable interoperability with FHIR

Using the Azure API for FHIR enables connect with any system that leverages FHIR APIs for read, write, search, and other functions. It can be used as a powerful tool to consolidate, normalize, and apply machine learning with clinical data from electronic health records, clinician and patient dashboards, remote monitoring programs, or with databases outside of an enterprise’s system that have FHIR APIs.

Control Data Access at Scale

Role-Based Access Control (RBAC) enables managing how the data is stored and accessed. Providing increased security and reducing administrative workload, we determine who has access to the datasets we create, based on role definitions we create for our environment.

Audit logs and tracking

Quickly track where the data is going with built-in audit logs. Track access, creation, modification, and reads within each data store.

Secure your data

We can now Protect PHI with unparalleled security intelligence. The data is isolated to a unique database per API instance and protected with multi-region failover. The Azure API for FHIR implements a layered, in-depth defense and advanced threat protection for the data.

*Image Credits and Reference: www.microsoft.com & www.hl7.org/fhir **Content Credits: DPS Bali

Dynamics 365 Health Azure API Integration

Dynamics 365 Health Azure API integration

by Interoperability

What is Dynamics 365 Health?

Dynamics 365 Health Accelerator rapidly develops healthcare solutions using data model and use case templates based on HL7/FHIR. The Microsoft Health Accelerator enables partners and customers to create new use cases and workflows using a FHIR-based data model. It includes the following:

Pre-built entities and forms: Access to a wide range of FHIR-based entities and relationships allowing for rapid development of new healthcare solutions

Compliance: Standard based model built on a foundation of trust within a platform that is fully compliant with industry compliance standards including HIPAA and HITRUST 

Care Team Visualization: A connected view of the care team associated with a patient and their roles that can be configured to include family and other related relationships

Patient Timeline: Presentation of clinical information about a patient in chronological order enabling providers to visualize all patient interactions and make informed care decisions 

Native CDM Support: Health entities unified with standard CDM entities ensuring consistency across applications which allows rapid and seamless integration to 3rd party EMR and EHR systems

Dynamics 365 Health Entities

The accelerator provides a specific set of primary entities in support of the FHIR HL7 specification. Below are the entities that have been provided in the solution 

  • Patients 
  • Practitioners 
  • Organizations 
  • Devices 
  • Locations 
  • Healthcare Services 
  • Care Plans 
  • Allergy Intolerances 
  • Clinical Impression Problems 
  • Risk Assessments 
  • Observations 
  • Specimens 
  • Encounters 
  • Episodes of care 
  • Medications 
  • Medication Requests 
  • Medication Administration 

Dynamics 365 Health with Azure API Integration for FHIR

We have created a Dynamics 365 Health with Azure API integration for FHIR and integrated Patients and Care Plan to Azure FHIR API. We are creating and updating Patient and Care Plan on Azure FHIR API on create and Update of Patient and Care Plan records in Dynamics 365 Health via Microsoft Flow. We have created a custom connector that connects to Azure FHIR API and created Actions in that Connector.

microsoft dynamics 365 azure api connection 1

 

How to Create a Patient from Dynamics 365 Health UI into Azure FHIR Server or Azure FHIR API?

  1. Login to Dynamics 365 Health App and click on Patients
    microsoft dynamics 365 azure 2

  2. Click on New
    microsoft dynamics 365 azure api connection check

  3. Fill in the details of the Patient and click Save
    microsoft dynamics 365 azure connection set up

  4. When we save the record in Dynamics 365 Health, this will create Patient in Azure FHIR API. We are checking this by Creating a Canvas App which get list of all Patients in Azure FHIR API.

Update Patients from Dynamics 365 Health UI into Azure FHIR Server or Azure FHIR API

  1. Open an existing Patient and update Date Of Birth to Sept 1, 2018.
    microsoft dynamics 365 azure health uI

  2. Click on Save
    microsoft dynamics 365 azure fhir

  3. When we save the record in Dynamics 365 Health, this will update Patient in Azure FHIR API. We are checking this by Creating a Canvas App which get list of all Patients in Azure FHIR API.

Extend Dynamics 365 Health and Add New Entities

Invoice Management

We have used standard Dynamics 365 CRM Invoice and Invoice Line as Invoice and Charge Item in Dynamics 365 Health.

We have also added few fields not present in Dynamics 365 as per FHIR HL7. 

We can use Product, Price List and Price List Item to setup Price of any service or Medication and then generate Invoices based on Product and Services Delivered.

*Image Credits and Reference: www.microsoft.com & www.hl7.org/fhir **Content Credits: DPS Bali

What is FHIR?

What is FHIR?

by Interoperability

FHIR is the latest development that’s gaining ground fast in the healthcare industry. It aims at breaking the barriers of seamless data exchange across various healthcare organizations that a patient typically interacts with. It is aiming at better patient care and enhanced patient engagement.

what is fhir?

FHIR stands for Fast Healthcare Interoperability Resources. Developed by Health Level Seven International (commonly known as HL7), it’s an interoperability specification for the exchange of real time health care information electronically. The aim of FHIR is to address the growing digitization of the healthcare industry and the need for patient records to be readily “available, discoverable, and understandable.” Here’s a closer look at FHIR, its potential benefits and challenges.

Purpose of FHIR

FHIR is a standard developed by HL7 in response to the growing use of electronic health records (EHRs) and aims to “simplify implementation without sacrificing information integrity.” FHIR builds on previous data format standards from HL7, like HL7 version 2.x and HL7 version 3.x. But it is easier to implement because it uses a modern web-based suite of API technology, including a HTTP-based RESTful protocol, HTML and Cascading Style Sheets for user interface integration, a choice of JSON, XML or RDF for data representation, and Atom for results.

FHIR provides an alternative to document-centric approaches by directly exposing discrete data elements as services. For example, basic elements of healthcare like patients, admissions, diagnostic reports and medications can each be retrieved and manipulated via their own resource URLs. FHIR was supported at an American Medical Informatics Association meeting by many EHR vendors which value its open and extensible nature. To do this, FHIR “leverages existing logical and theoretical models to provide a consistent, easy to implement, and rigorous mechanism for exchanging data between healthcare applications.” The goal is to build a base set of resources that satisfy the majority of common use cases.

Benefits of using FHIR

FHIR can be used as a stand-alone data exchange standard or in conjunction with existing standards. Essentially, the goal of FHIR is to standardize the exchange of healthcare information, enabling healthcare providers and administrators to easily share patient information even when they’re using different software systems. With FHIR, each resource is associated with a unique identifier. Much like URLs make it easy to find a specific web page regardless of the device or browser you’re using, FHIR makes it possible to access the right information from any application or device.

By creating standard URLs for packets of information, FHIR eliminates the need to exchange individual documents or data back and forth between systems, while ensuring that disparate applications can point to the right information, and the same version of that information, simultaneously. This would allow developers to build more user-friendly applications with web-browser-esque functionality that ensure fast, reliable access to accurate data regardless of the EHR or other application being used, which in turn offers the potential for several benefits, such as:

  • Easy implementation
  • Improves the speed of healthcare delivery by making data readily accessible
  • Standardizes and structures data for automated clinical support and other machine-based processing
  • Eliminates the time-consuming document-based exchange of information, feeding information directly into workflows

Challenges in Healthcare and how FHIR solves these challenges?

Healthcare records are increasingly becoming digitized. As patients move around the healthcare ecosystem, their electronic health records must be available, discoverable, and understandable. Further, to support automated clinical decision support and other machine-based processing, the data must also be structured and standardized. (See Coming digital challenges in healthcare)

HL7 has been addressing these challenges by producing healthcare data exchange and information modeling standards for over 20 years. This is a new specification based on emerging industry approaches, but informed by years of lessons around requirements, successes and challenges gained through defining and implementing HL7 v2, HL7 v3 and the RIM, and CDA. It can be used as a stand-alone data exchange standard but can and will also be used in partnership with existing widely used standards. 

FHIR aims to simplify implementation without sacrificing information integrity. It leverages existing logical and theoretical models to provide a consistent, easy to implement, and rigorous mechanism for exchanging data between healthcare applications. It has built-in mechanisms for traceability to the HL7 RIM and other important content models. This ensures alignment to HL7’s previously defined patterns and best practices without requiring the implementer to have intimate knowledge of the RIM or any HL7 v3 derivations.

Components of FHIR

The basic building block in FHIR is a Resource. All exchangeable content is defined as a resource. Resources all share the following set of characteristics:

  • A common way to define and represent them, building them from data types that define common reusable patterns of elements
  • A common set of metadata
  • A human readable part

What does FHIR do?

what does FHIR do?

FHIR uses standardized APIs to create plug-and-play applications. This serves to remove the gaps and errors that the current document-based system of information exchange brings with it. An application developed for FHIR can be plugged into any EHR and information can be obtained; there is no scope for information to be lost, and it’s easier to obtain specific details instead of a large volume of data to sift through.

What can FHIR do for Patients and Healthcare Service Providers?

What can FHIR do for Patients and Healthcare Service Providers?

There are a lot of expectations from FHIR with regards to improving patient engagement, seamless data transfer, and developing better care management programs. For patients, FHIR makes it easier to contact healthcare service providers by eliminating the hassle of having multiple portals for the same. This can also be used for obtaining smaller, specific data from eHealth or mHealth apps, wearable devices, monitors, and other sources to perform health analytics and make estimates, thus helping in preventive care. It can also offer a holistic and comprehensive picture of the patient’s health, medications, and episodes.

FHIR for Data Monitoring

What is FHIR? How does FHIR help with monitoring?

FHIR supports a variety of applications and data sources, which makes it easy to access data snippets from various channels. Monitoring the mass of healthcare data is tough. It is possible to save a lot of time by enabling focussed data access, and converting this specific data into actionable insights.

*Image Credits and Reference: www.hl7.org/fhir **Content Credits: DPS Bali