Modernizing HIEs: Future-Forward Interoperable Data Exchange

The client: A non-profit health information exchange (HIE) network that provides data infrastructure across the continuum of care in a US mid-western state. The network routes and processes data for over 14 million patients, receives over 98% admission notifications from network-hospitals and reports over 8.3 billion cumulative messages exchanged.

The issue: The changing industry landscape requires that HIEs provide enhanced value to citizens, and evolve with growing population needs, while maintaining cost-effectiveness. The client was locked into a siloed legacy proprietary data platform for decades. The legacy vendor’s proprietary model had become increasingly expensive to maintain, upgrade, change and scale, since their IT architecture was not based on open standards. As a result, the client needed to find an alternative solution that would enable interoperable data exchange in alignment with ONC and CMS mandates. The client searched for a vendor-solution that could implement commercial FHIR^®-native infrastructure, upon which they could integrate and build their own resources.

The objective: The client’s main goal was to consolidate all their legacy systems and modernize their IT infrastructure, and data exchange processes by 2025. This goal was part of their IT modernization strategy; to provide a network architecture that enabled centralized data access, streamlined exchange and reporting without being locked into a proprietary vendor platform. The client had several requirements to achieve their objective:

- Ownership - The requirement to control their own data, processes and speed of innovation, including building and evolving modules, instead of outsourcing this to their IT vendor.

- Cost of ownership - Low TCO or total cost of ownership, which includes the initial investment and operating costs for a technology solution. They also needed an IT platform that enabled them to upgrade as they needed, in a cost-effective way.

- Quality data - The consistent availability of good data quality which is unduplicated, complete and contextual in order to run timely reports, quality management initiatives and predictive analytics.

- Shared infrastructure - Continual enhancement of core shared services across the network like robust security, authorization measures, identity and consent management.

- Data Utility - The ability to seamlessly plug-in third-party software for use-cases such as clinical decision support (CDS), patient portals, prior authorization, Revenue Cycle Management (RCM) etc.

- Innovation - Flexible and agnostic cloud scalability—to handle increasing volumes of data from a variety of sources—along with seamless interoperability, enabling data access across all points-of-care in near real-time. A mix of cloud and on-premise data centers were unable to keep up with increasing demand and caused inefficient workflows and increased down-time.

- Compliance - The technology infrastructure had to be compliant with ONC and CMS FHIR mandates, as well as future regulations.

After a rigorous evaluation process, to help them choose a FHIR^® vendor-partner, Smile emerged as the solution of choice to meet the client’s interoperability and modernization requirements. 

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 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.