FHIR Testing Helps Healthcare Projects Accelerate Adoption

Several large healthcare payers will make history this weekend at a Hyatt in San Antonio as the HL7 Da Vinci Project sets out to test their first four use cases at the HL7 FHIR Connectathon. The membership of this highly collaborative project consists of several large payers, providers, and partner technology companies that have set out to leverage the HL7© FHIR© standard to improve healthcare. They will make it better by ensuring hospitals, physicians, and other healthcare providers have access to data that is typically stored in insurance company systems at the right time and place. “Healthcare providers benefit by seeing what insurance companies know about a patient” said Dr. Viet Nguyen, Technical Director for Da Vinci. “The FHIR standard and these new Da Vinci Implementation Guides will enable payers to contribute at the point of care like never before.” AEGIS.net has been working with Da Vinci leadership and members since the project’s inception and will provide development tools and subject matter experts to help technology leaders from these payer and provider organizations accomplish their goals.

Payers help providers improve healthcare:

Development engineers will build software that can establish a connection between healthcare payers and providers.  One Da Vinci use case facilitates reporting of medication reconciliation which is a patient safety and quality concern for many healthcare providers. Another use case connects physician systems and health plans, so that a physician can receive relevant clinical information about the patient’s medical history. These are significant strides forward, but perhaps most game-changing is that it will enable a provider team to see prior authorization or documentation requirements for covered services in the clinical workflow. This will help patients and providers understand their options for care. The use cases have been defined using subject matter experts across the stakeholders to find the pain points in the payer – provider information sharing process. Once a business use case comes into focus, the team works to bring the project into HL7 to develop a targeted implementation guide and Da Vinci funds a reference implementation that enables more companies to emulate the solution. The end result will be many payers and providers using well defined APIs constrained in a consistent way to create scalable broad data interoperability throughout the industry.

How FHIR implementation works in a non-technical nutshell:

The HL7 FHIR standard constrains APIs into helpful resource types to be more applicable and effective in the healthcare environment. This allows systems to use data in a consistent, safe, and secure way. Industry groups like Da Vinci then develop FHIR Profiles and Implementation guides to further define and constrain FHIR Resources. This ensures healthcare providers and payers are using the same data constraints and structures for exchange. Determining what data constraints should be used is complicated and sometimes the documentation (implementation guides) that developers use to ensure systems are built correctly can be even more complicated.

The case for better testing:

If adoption of a standard such as FHIR is not consistent across each layer of use (FHIR Resource, Profile, and Implementation Guide) true interoperability will not be realized. Instead, history will repeat itself and a new wave of highlyproprietary FHIR APIs will continue to expand in the healthcare marketplace, perpetuating the need for expensive custom interface work and middleware. Organizations will claim to be using the FHIR standard and sell their software to hospitals all over the country. CIOs will be disheartened to say the least when they realize their FHIR systems do not enable direct interfaces because builders used a different implementation guide, profile, or version of FHIR. The solution is to ensure broad and consistent adoption of the HL7 FHIR standard through thorough test-driven development with conformance testing against each layer of the standard and solid version control. Validating that system A talks to system B is not enough, because when system C, D, and E enter the picture in a production environment, they may not work. Worse – it could require breaking changes to the first two in order to make a new system work.

How Da Vinci is the project that’s  is set up to get interoperability right:

Da Vinci members have identified solutions that will enhance data exchange between payers and providers, but they are not stopping there. This weekend it will be all hands on deck as developers thoroughly test their systems to make sure data moves from one system to another. What’s different about Da Vinci is that they will also validate conformance to their implementation guides by using advanced automated test scripts that check every level of the API – FHIR resource, profile, and implementation guide in concert. This conformance testing is a huge part of making sure Da Vinci resources are repeatable and scalable for all. Without conformance testing, there is no way to ensure implementations of the guides are consistent – which is what makes a standard work. Da Vinci intends to ensure that their implementation guides see wide spread adoption by providing development and testing resources through Touchstone by AEGIS.

Touchstone is a cloud-based system that facilitates the development of FHIR-based technologies and validates conformance to the HL7 FHIR Standard Resources, system conformance statements, and implementation guides such as the ones that Da Vinci has created. The system provides just-in-time feedback for code in progress by identifying and reporting on what does and does not match the expected results. It also provides continuous testing even after systems are deployed.

Da Vinci members and others can rapidly increase the adoption rate for their implementation guides by using Touchstone. Developer time is expensive, so building systems in weeks instead of months is a huge financial savings for any healthcare company. One electronic medical record reported having built their first FHIR based system in less than 22 days and was able to immediately connect to ancillary systems because the Touchstone tool guided them through the implementation process. Touchstone users can run ongoing or continuous tests which means they more effectively share data by ensuring conformance to the specification is 100% even after deployment. Upgrades in healthcare systems happen frequently so software testing needs to also happen frequently. This will ensure that bugs are found and corrected immediately. When conformance to a standard is assumed but not validated – companies run the risk of producing a system that will not effectively transport data with other systems even when they are using the same implementation guides.

AEGIS proudly supports the Da Vinci project and we look forward to seeing the dynamic folks on this team improve patient outcomes by ensuring access to more complete patient information in clinical workflow. Come see for yourself how these payers have united to improve care through a demonstration called “Unlocking Payer Data to Improve Care” at the HIMSS19 Interoperability Showcase in Hall F at the Orlando Convention Center.

For more information about Touchstone please reach out to Sandy Vance at sandy.vance@aegis.net





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