New Digital measures can deliver significantly better value and be more relevant because they make use of increasingly more structured clinical data. There are multiple ways to source clinical data and they come from various sources. With the advancement of interoperability, most significantly the FHIR® standard, collection fata from various data sources will become less burdensome while the uniformity of the data will benefit better measure results and insights.
Who is involved in leveraging standardized clinical data?
- Your own interoperability and clinical data teams
- Data vendors and interoperability
- Data sources (provider systems, EMR vendors)
- Aggregators (e.g. HIEs)
- Registries
Initially, there are many cases where data is not available in FHIR® from the source. Therefore, the data need to be transformed into FHIR® at some point, but no later than just before it is used for digital quality. The two major ways to get clinical data in FHIR® are
FHIR from the Source
In this case the system where the data originates can provide clinical data via a FHIR API (see also BulkFHIR).
Just-in-Time FHIR
Refers to the capability to transform non-FHIR clinical data into the FHIR format just as it is needed for processing with a digital quality use case (in digital quality software using a CQL execution engine, executing FHIR-CQL measures).
Data Quality Management and Best Practices
A key consideration for clinical data, not just for digital quality, is data quality. It needs to be planned for managed proactively. While FHIR data from the source might eventually be so standardized and mature that data quality can be assumed to be sufficient, we need to expect for the foreseeable future that this is not the case.
Validation programs can check or ensure data quality (e.g. PSVs performed by HEDIS auditors, NCQA DAV program) but other solutions may be needed to proactively manage data to be properly formatted, contain valid and standardized codes (value sets) and more.
In addition, there are other best practices that are important to implement clinical data operations around FHIR, which include
- Using Aggregators (HIEs)
- Implementing standard operating models for use cases
- Clinical Data Integration (CDI) for Payers
Starting Early has Benefits
Developing and implementing a clinical data strategy towards FHIR takes time and needs to be implemented ahead of going live with digital quality operations. However, even if there may be time to put that off a little longer, benefits from starting right away are compelling.
Often, initiatives take longer than expected and unforeseeable complications slow them down. But having more complete, timely and standardized clinical data in FHIR can benefit tradition quality use case and operations, can improve other use cases (e.g. risk adjustment) and simplify clinical data operations.
