Wednesday, September 11 | EHR Solutions and Operations, Care Coordination, Interoperability

Beyond the Spectrum

By Andrew Fosnacht, Senior Manager of Interoperability, Netsmart

At the end of the 1940s, approximately 9% of the U.S. population had a TV. By the end of the 1950s, that number skyrocketed to 90%. What a revolution! For the latter half of the 20th century, the entire entertainment industry was built on spectrum, and companies that recognized this could exploit it. Those who saw the writing on the wall were able to use the television platform very successfully.

However, the problem with spectrum is the same as its benefit: scarcity. In an industry built on spectrum, mechanisms for content delivery are few, and the same is true of organizations that control the bands of the spectrum. For example, in the television and entertainment industry, the bands of spectrum were called “channels.” Because the way the electromagnetic spectrum works, sufficient space between those channels is necessary so they don’t overlap. This is why we had channels 2, 4, 7, 17, etc. going up to a final end point where you would lap back to channel 2, usually realizing nothing was on and the cycle continued. This brings us to our second problem with spectrum. With industries that built on it, the content/product delivery was less about demand and more about what organizations wanted to supply. If there are 10 channels and one corporation owns five of them, you’re completely at their mercy for programming and content. However, everything changed with the internet.
With the advent of the internet, the concept of spectrum fizzled. The business model that worked so well for the 50 years prior to its creation, no longer worked. The internet has unlimited content, which means for a cable company to maintain my attention (and as a function of that, my money,) they would need to schedule programming that included countless hours of dogs doing hilarious things. That’s just not feasible. And so, everything changed. To the point that even having infinite content was not good enough! The content has to be curated for its audience’s preferences. Why show me ads for lawnmowers when I’m looking online for clothes?
So, how does this relate to healthcare? We’re seeing the same happen with health data! For years, the sharing of data existed on a spectrum. Want to share demographic data with a vendor or a provider? An HL7 ADT will tell you what can be shared and what can’t be shared. Want to share clinical data with a vendor or a provider? There is a limited set of data that is contained in a Continuity of Care document (CCD). Providers and consumers made the best of limited standards and portals that allowed for the sharing of data on a finite spectrum. It drove us forward, but we’re on the precipice of change. Enter: FHIR. For those not familiar, FHIR (pronounced “fire”) stands for Fast Healthcare Interoperability Resource. Like the internet did with entertainment, FHIR is shaping the future of healthcare. It is the infinite spectrum of healthcare data, and as I attended the API workshop at the Office of the National Coordinator’s Interoperability Forum in August, it’s clear there are some of the exact same issues with this new technology as we had when the internet was created. FHIR will allow people to have access to virtually all health data at their fingertips. However, FHIR poses a lot of questions and not a lot of answers regarding data protection, visibility and more. 
What strategies did successful companies use when the game changed in the internet age that might apply to the changing healthcare interoperability landscape? The first lesson we learned was the value of adoption. Companies that are slow on the uptake or that wait until someone else does it first will be the companies that won’t make it. It’s crucial to partner with a vendor such as Netsmart that knows the value of the changing market and where we, our clients, and their consumers fit in it. 
The second lesson we can take is the value of content. The amount of data we will be able to exchange in the very near future will increase exponentially. In the FHIR standard, there are actually no required values. Anything can be shared to anyone. This will open more opportunities to share data with entities like social service organizations that do not have HIPAA compliant systems, allowing us to strip out the “patient” components and just send what is needed. In addition, with this new technology, people will truly be able to start driving their own care and accessing the data they want with virtually no limitations.
From the provider side, the ONC proposed a standard data set that must be presented to people for free. However, the real opportunity is in the value-added services that go above and beyond what’s currently in a CCD. Today, we can show a person in a portal that a lab result came back showing they are pre-diabetic. In the future, through FHIR and other APIs, we can show them the lab result, suggest risk mitigation strategies through push notifications, integrate with the step counter on their mobile device, and send manually entered activity of daily living data to their payer and their chart to offer a personalized incentives and reduced premiums if they hit specific curated activity and nutrition targets. For those with Substance Use Disorder or Alcohol Use Disorder, your health app can integrate via FHIR with your Maps app to geofence any location marked as a “bar” and send an alert to a care team member or coach so intervention can take place.
The final lesson we can learn is one regarding mobility.  We will see mobility play a major role in way we make data available to consumers and providers, the way it is integrated with native and foreign platforms, and even how we enable the provision of care.  
The times are certainly changing, and there are many lessons we can learn from the past in order to successfully move into the future. The days of limited spectrum and narrowly built interoperability standards are at an end. FHIR is creating a marketplace of infinite spectrum where people will have access to the kind of health information they have never had before, in a way they have not been able to access it before. The trick is to find a partner who sees this shift and knows how to manage the change it will bring. Is your healthcare IT partner up to the challenge?



Meet the Author

Andrew Fosnacht · Senior Manager of Interoperability, Netsmart

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