Fighting a Pandemic: Using FHIR to enable Better Patient Outcomes

With almost the entire world under a lockdown and nearly everything coming to a standstill, one industry that is expected to work harder is the healthcare and hospital setting. With the increased use of telemedicine and remote patient monitoring in these tough times, it is necessary that patient data is accurately captured and shared with the relevant stakeholders. Thanks to FHIR standards, healthcare IT can develop solutions to facilitate this. The scope of these solutions includes patient self-assessment, remote clinical assessment, and telemedicine.

EHR/EMR systems can capture patient information and send it to physicians. FHIR has resources (data formats and elements) and APIs (Application Programming Interface) to exchange data to and from the EHR (Electronic Health Record). Specific resources are defined under FHIR standards to be used as such. These resources are leveraged for sending required information across systems.

FHIR interoperability can be achieved by using either integration engines such as Mirth Connect, Iguana, Biztalk, etc., or simply by leveraging APIs of different EHR systems as one-to-one integration. Interoperability can also be achieved by using the Redox or Sansoro engine, which converts the data into one universal format using a Json-like architecture. It is worth noting that choosing the right approach and architecture depends on business needs, and one should select the best approach keeping in mind the organization’s current and future needs.

The list of resources required for interchanging data are referenced below. Please note that this is not a comprehensive list. The table below is just a general guideline; the list of resources will depend on the vastness of the application.

Use Cases	Parameters	FHIR resource
Patient self-assessment	1) Demographics (Age, gender) 2) Chief complaints 3) Past history	Patient, Observation
Clinical assessment	1) Demographics 2) Organizational Data 3)      Vital Signs 4) Exposure History 5) Symptoms 6) Diagnostics Tests 7) Diagnosis	Patient, Diagnostic report, Specimen, Observation, Clinical impression, Risk assessment, care plan, Questionnaire, Questionnaire response

While designing applications for these as well as other use cases specific to COVID-19, ISVs should keep the following factors in mind:

• Availability of a questionnaire tool to collect patient responses specific to COVID-19
• Provision for the patient to inform the doctor about COVID-19 symptoms. This enables the doctor to test the patient using a COVID-19 test kit. If positive, the patient and the healthcare workers can take adequate precautions before an in-person consultation and authorities may be informed about it.
• Streamlining workflows for remote/telehealth consultations
• Ways of keeping patients out of the waiting room to decrease infection risk
• Arrangements to track home quarantined patients via telemedicine

To test the application, ISVs can use synthetic/test data for COVID-19. However, organizations that already have FHIR implemented for other workflows will still be required to make amendments and test to include FHIR resources as such.

In these tough times, FHIR can be used to create interoperable solutions and applications to help healthcare workers. However, FHIR, and its implementation, is inherently complex. By following established patient data communication standards, it becomes easier for providers to easily share patient data as they can ensure that all stakeholders are speaking the same language. Nitor Infotech, with vast experience working on FHIR since DSTU1, can help companies planning to fast-track development and data sharing efforts during these tough times.

Our specialists leverage FHIR to ensure that providers get standardized patient data for effective clinical treatment, thus improving the chances of better patient outcomes. Feel free to write to us for more information.