Discovering the Benefits of Health Data Interoperability Beyond Compliance


ASSYST OnPoint xChange features an informative dialog on Health Data Interoperability. The maturity of the standards, regulatory mandates, and legislative compliance drive the adoption of Fast Healthcare Interoperability Resources (FHIR®). There are immense benefits at the provider-patient-payer levels, empowering patients to be in charge of their healthcare access. However, there can be benefits beyond the level of information sharing. 

Mr. Vinay Shirke, Lead of ASSYST’s End-to-End Cloud based FHIR Solution “Hephaestus” Product Development and CIO, joins Mr. Khalil Zebdi, EVP Health IT solution, and Federal Business Development to discuss their journey to create Hephaestus

They also explore the underlying technologies which support a high-quality FHIR® solution, the capabilities consumers should expect, and the potential interoperability standards benefits beyond compliance that FHIR® standards can provide for the Greater Healthcare Ecosystem, including Research and Nonprofit Organizations.

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Vinay Shirke: Hello Khalil, witnessing current trends seen by healthcare providers adopting interoperability has been fascinating. Healthcare IT vendors seem keen on FHIR® based solutions to support data exchange within their technology ecosystem. With the recent introduction of government mandates requiring compliance for information sharing with patients, FHIR® is becoming more of obligation providers must meet. When we began developing Hephaestus, I remember what spurred your interest in Interoperability and led you to the idea that ASSYST should create our own FHIR® solution.

Khalil Zebdi: Vinay, having been working with HHS agencies featuring CMS, HRSA, and FDA for the past 15 years, we have held the privilege of developing close relationships I will cherish with these agencies and the people within them. A little over five years ago, as I was having lunch with a client from the CMS, she began to talk to me about the 21st Century Cures Act and the vision that she believed the legislation would drive for the future of healthcare IT. While we had heard about FHIR® and the concept of Interoperability, we weren’t quite sure how it would translate to real world use cases. But I couldn’t help myself but dive into research. As I dug deeper, I realized that FHIR® isn’t not only going to become an opportunity for IT vendors as providers would have to meet compliance but also a concept that will improve the overall quality of care we receive as patients.

When I dropped the idea of developing a FHIR® solution to the team, we evaluated the market and noticed that there weren’t many players engaged in FHIR®, which only made us more eager to jump right in. But as we began brainstorming, we asked ourselves, how can we be different from the other vendors? Many developers had stand-up FHIR® servers that performed the parsing and validation functions and housed FHIR® data. We researched many of the progressing trends occurring in HL7 and FHIR® but also with EMR vendors and Public Health IT. We wanted to exploit the experience we had obtained by working with various Federal, State, Local and Commercial agencies, as we already understood what it took to meet federal compliance with HIPAA and develop a federally approved software system. This drew us to the conclusion that whatever our product was going to be, it had to support the client in adopting FHIR®, maintain flexibility to the various use cases, be scalable to adapt to an expanding data environment and provide users the ability to visualize their data. 

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Thus, we created the vision for Hephaestus! Named after the God of Fire, we developed Hephaestus to bring change as a scalable solution that would aid organizations in transitioning from their use of legacy data formats to the most recent version of FHIR®. Hephaestus accelerates adopting and implementing the HL7 FHIR® standard by automating metadata exploration, data mapping, parsing, validating, transmission, API, and Business Intelligence (BI) with a data Visualization Dashboard. Being built in a Six-Component Microservice architecture and Cloud compatible, there are various use cases for ample providers that Hephaestus provides an answer for. 

Khalil Zebdi: Vinay, when you kicked off developing Hephaestus, what tools and technologies did you feel were best to augment a FHIR® solution of this caliber? If I’m a Healthcare IT vendor, a provider, or an industry stakeholder, what approaches should I take when selecting a FHIR® solution that can aid the transition process? And what capabilities should I expect from a FHIR® solution?

Vinay Shirke: Khalil, as you explained earlier, from years of market research and experience with healthcare IT, we were in a good place to identify technologies and tools to construct a FHIR® solution, all of which we felt were necessary to build into Hephaestus. 

As a basis, your FHIR® solutions should be able to effectively parse and validate non-FHIR® data sets into the most recent and relevant FHIR® format to be housed within a select FHIR® server so it can effectively be used for data exchange across platforms. The process of transforming data sets from legacy formats to FHIR® is the most important step, as many providers use varying data set formats, causing difficulties for users to remodel their data sets properly. Aggregated data collection can come from various sources and formats such as Excel sheets, CSV., XML, and JSON. Vendors are looking to build their apps with FHIR® to facilitate data ingestion from these sources. The platform should be able to collect metadata sets, analyze them and correlate them into schema formats (FHIR®Spy). For example, we built Hephaestus with SMART HL7 Bulk FHIR® to automate the uploading of Bulk FHIR® (large volumes of FHIR® data) data from various sources. In addition, users should be able to standardize their target schema formats reflecting their metrics for analysis fitting their business requirements, which is why we designed an interface enabling customization functions to format schemas. A proper solution should be able to interface with the source schemas (incoming datasets) and target schemas (FHIR® or defined metrics) and map out the transformation process and with the implementation of AI/ML capabilities stemming from the FHIR® server to automatically recommend the mapping of various data elements from the source schema to the target schema from previous activity (FHIR®Bricks). 

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A powerful parsing engine within your FHIR® server is imperative to complete the transformation process. We strongly recommend using a FHIR® server that leverages AI/ML to break down and restructure the various source data sets, re-structure them into the targeted FHIR® format, and prepare the dataset in a consumable format, then direct them to their appropriate storage location (FHIR®Proof). This step should also include a good validation tool, as we want to maintain the validity of data sets and their contents during the restructuring process. In addition, we believe that a platform should also be Cloud- compatible with supporting evolving data demands in Healthcare. From our years of experience, we have learned that everyone in the industry is adopting the cloud, including HHS agencies managing programs with the private sector, and are beginning to migrate their Healthcare systems to the cloud. So we felt it was imperative to make Hephaestus a Cloud-based solution.

Then comes the next step, which is the actual exchange of data. We identified SMART on FHIR® during our research. We built its RESTful API frameworks into Hephaestus, which not only augments your data collection process through quick exchanges of small and large data sets and contains authorization standards to govern data exchange. It clearly defines workload functions that guide applications to securely exchange data amongst each other efficiently while remaining versatile to different volumes of data sets (FHIR® Break). SMART on FHIR® supports integration with Bulk FHIR® Servers, which enables gathering large data sets using Bulk FHIR® API and meets compliance with the 21st Century Cures Act. Using the OAuth 2.0 Token Authentication standard, product and business owners can set controls on access levels using User-Managed Access (UMA) 2.0 protocol, which grants users tokens for a finite time for engagement in health information exchange. We feel that this is important to a successful adoption of FHIR® to assure all stakeholders that while their data is more open for sharing, it is also protected.

Lastly, we advise integrating a good analytical tool into your solution. Using SMART on FHIR® enables clients to integrate many open-source applications in the SMART App Gallery. These can be anything from patient dashboards to data visualization tools that can be used for reporting and analytics. For example, we are very enthusiastic about Superset. This open-source Data Visualization tool (FHIR® BI) is customizable. It enables users to define their metrics of measurement and Key Performance Indicators (KPI) and customize their interactive dashboards for analysis. Integrated dashboards provide organizations autonomy to slice and dice data with the AI/ML component of their FHIR® server and their aggregated health data and create dynamic graphical representations of their patients and the populations they serve. 

Khalil Zebdi: We see the immediate need for healthcare providers to adopt FHIR® and the benefits it can provide to improve the overall quality of healthcare. However, with access to all that data, do you believe there are healthcare objectives that FHIR® beyond compliance can support? For example, can FHIR® support data analysis and construction of open health data products for Public Health initiatives?

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Vinay Shirke: Today’s age in technology is moving more towards shared services and building open data models for services. Access to networks and the creation of open data services can aid Healthcare objectives for many organizations that use healthcare data programs to support their operational model. Interoperability can be the tethering framework for bringing together enterprises' health information data to build foundations of data models supporting healthcare programs, whether for private businesses or public health partners. We can use FHIR® to build open systems leveraging Cloud capabilities for ingesting and organizing Health data from a shared collection of participating stakeholders using FHIR® Bulk API exchanges to visualize populations based on their aggregate data in support of large-scale healthcare Programs. For instance, the Bulk FHIR® protocol, while not specifically established for data analytics and shared service programs, can interface with open data programs to define population groups and support information sharing across communities and population taxonomies. Organizations, Communities, and Public Health Stakeholders engaging in programs collecting large quantities of healthcare data in efforts to gain insights on trends in patient populations can adopt these standards to expedite data exchange, hone in requirements, customize metrics for data collection for analytical objectives, all of which will improve accuracy and speed of research and program operations. 

How will this translate to the real world? We can support informative public platforms such as websites reporting important information with real time numbers on occurring phenomena such as infectious diseases or available hospital beds in a certain region. We can properly evaluate health conditions in a particular labor environment and use it to guide occupational safety policies. Grantors can gain direct analytical insight into their grantee constituents' activity & performance to more effectively manage their programs and allocate grants and resources in a cost efficient way. Clinical trials involved with the release of critical drugs for treatment will have access to obtaining accurate data that can improve trial processes and expedite approvals. Public health agencies can collect data models reflecting populations to improve operational strategy and provide information relevant citizen populations. 

With greater data access, we can be more informed in how we conduct business and, as a result, provide better services and products to the people we serve. Promoting a more data driven culture across the healthcare industry will significantly help business processes mature and benefit with increased efficiency and the ability to integrate with modernized technologies. 

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Hephaestus is ASSYST's most recent innovation to come out of our Green Accelerator Program, designed, developed, and implemented for Healthcare Providers, Government Health Agencies, Health IT Companies, and Health Insurance Companies. Hephaestus is an eloquent, lightweight, low-code application platform that provides customers with the component architecture required to implement the FHIR® specification. Discover more at

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As a Health IT Systems Integrator and Platform Solutions provider, ASSYST helps US government health and human services agencies, research, and nonprofit organizations to deliver high-quality health and wellness services. Our customers include the Centers for Medicare and Medicaid Services (CMS), Food and Drug Administration (FDA), Health Research and Services Administration (HRSA), Program Support Center (PSC), and many State and Local Government agencies. ASSYST has been an industry leader in data interoperability, trusted data exchange, compliance, metadata, taxonomy, open data, and dissemination initiatives for over 25 years. In addition to HL7® FHIR®, ASSYST delivers solutions complying with data exchange standards, including XML, GJXDM, NIEM, XBRL, EDI, X12, and SDMX. ASSYST is an HL7 Gold Level member organization.

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