Modernizing HIEs: Future-Forward Interoperable Data Exchange

Vendor and Solution Evaluation

Continuous IT modernization is a fundamental process for any organization’s current and future operations. The client’s objective required the replacement of their entire existing legacy vendor system. To evaluate the depth and breadth of solutions for this vital and complex task, they created a thorough and comprehensive procurement process. As such, over a period of 1.5 years, a spectrum of evaluators—from their entire executive team to frontline staff across the network—tested hundreds of features, capabilities, use-cases and processes within their sandbox (test) environment through to Limited Production Release (LPR). 

The evaluation process tested Smile’s capabilities with other vendors, including, but not limited to: 

• Ingestion of various types and sources of data into FHIR, and pulling outputs from over 5,600 care entities in the network, without compromising speed and security.

• Modular architecture with elements that could be turned off and on, on demand—like MDM (Master Data Management) and HL7 V2 messaging compliant with USCDI.

• Validating and verifying terminology and code systems—clinical vocabulary and groups of codes that correspond to procedures and treatments—that allow relevant data to be mined from CDAs (Clinical Document Architectures).  

• Relevant availability of real-time event driven data in order to deliver the best clinical decisions support (CDS).

• Managing shared utilities such as security measures, identity and consent management.

• Enhanced experience for users—patients, providers and payers—for everyday operations and consumer service.

In addition, Smile’s industry expertise is unparalleled. Smile is the maintainer of HAPI FHIR—the world’s prevailing open source reference implementation of FHIR. The team at Smile actively leads and participates in over 31 Implementation Guide (IG) Working Groups including CARIN IG, the framework that outlines how to integrate third party consumer apps into FHIR in accordance with CMS Patient Access API Rules. With experience completing over 160 successful global implementations, Smile’s team demonstrated depth of knowledge and expertise when challenges arose during the evaluation process. For these reasons Smile emerged as the vendor-solution of choice after the long, demonstration-based evaluation process.

The Implemented Solution

The client network which includes over 140 hospitals and over 1,000 clinical facilities now runs on Smile’s HDP (Health Data Platform)—a FHIR-native IT infrastructure that is completely connected and integrated in the back-end. With a consolidated and connected base architecture, the client can now:

• Provide complete, comprehensive and longitudinal patient records across their network.

• Offer secure and relevant real-time access to clinicians, so they can provide more informed, better coordinated care to the population they serve

• Support more of the continuum of care by integrating third-party apps, including multiple patient and provider viewers and an independent FHIR-based EMPI (Enterprise Master Patient Index) solution.
  
  

The HDP’s proven capabilities not only satisfied all the client’s objectives (outlined above) to modernize their entire network architecture, but also set the foundation for future growth and continued innovation. 

Future Growth

With a FHIR-native data modernization implementation, the client can do more with their data, now that it is standardized, clean, shareable, secure, contextual and interoperable. The modernization project provides the basis for new strategic investments. Smile is supporting some of these strategic investments, including: 

• Enhancing positive impact on patient outcomes, efficient care coordination and cost savings with Smile’s FHIR and CQL (clinical quality language) solutions. FHIR and CQL offer refined clinical reasoning (CR) and clinical quality management (CQM) across the network.

• Sharing SDoH (Social Drivers of Health) data securely to support care coordination and population health initiatives in underserved communities.

• Analytic-driven policies to bridge health inequities and serve vulnerable populations better.

• Enabling value-based care initiatives, PA (prior authorization) and payer-to-payer solutions, by creating custom use cases within the network to cost-savings, revenue-generation and patient satisfaction.