Stoking the FHIR at HIMSS24

A person could be forgiven for being completely overwhelmed by HIMSS. Almost everything about it can provoke a sensory overload - from the colorful and jam-packed mobile app, to the massive convention center, to the inconceivably large exhibit hall. With that said, there is SO much that can be gleaned from attending HIMSS and managing your time effectively, and so I’d like to share my experience from this year’s HIMSS24 conference in Orlando, Florida.

I decided to arrive in Orlando on Monday afternoon, and so was unable to attend any of the pre-conference sessions, but as I understand it, the sessions around FHIR and Interoperability were highly effective and educational - kudos to those of you that were able to attend these. My HIMSS24 experience began with Tuesday morning’s keynote session. We heard from Hal Wolf III, president of HIMSS, as well as Robert Garrett, CEO of Hackensack Meridian Health, about how AI can drive real change in improving patient experiences. AI, naturally, was at the forefront of many of the sessions and exhibitions at HIMSS this year. Topping off the keynote was an only mildly cringe-inducing choreographed song-and-dance routine. On to the rest of the day!

Tuesday continued with sessions around Social Determinants of Health (SDOH), and the Trusted Exchange Framework and Common Agreement (TEFCA), but I found my groove with two sessions around electronic Prior Authorization. The first of these was a presentation from Regence BCBS in conjunction with Epic that centered around Regence building a SMART-on-FHIR application that could be launched from the EHR with the purpose of allowing providers to quickly determine if Prior Authorization is required for a service they want to perform on a patient; then provide the needed data and documentation requirements to request the Prior Auth if one is needed; then finally provide an interface of the provider to actually submit the Prior Auth request along with the necessary documentation. According to Regence, 80% of providers within their local networks have adopted use of this new FHIR-based interface for requesting prior authorization.

According to their analysis, after over 3500 inquiries, they show that 99% of inquiries get a response to the question “Is prior auth required for this service?” within 20 seconds. For those that reach the stage of actually submitting the requests, 95% get a response within 20 seconds. In the legacy world of Prior Authorization, providers often have to spend a long time on the phone - most of this on hold - waiting for answers that are now taking less than 20 seconds via the FHIR interface. The second session on Prior Auth from Tuesday was a proof of concept around the Da Vinci Burden Reduction implementation guides for electronic Prior Auth that had been implemented by BCBS of Florida. Powerful insights and important lessons learned were gleaned from this session, which reinforced the need for interoperable systems that can facilitate an efficient exchange of data for the purpose of prior authorization.

Next up was a session from the Centers for Disease Control (CDC) around their efforts to promote interoperable public health. Bear in mind that the government pavilion was on the opposite end of the convention center from the main exhibit hall, a perilously long trek that I and my colleagues made several times a day, back and forth. This - and all of the other Government-related sessions - was well worth it. The CDC demonstrated that they have used some of the COVID recovery funds made available to them to implement a standards-based public health data exchange to improve electronic Case Reporting (eCR). Their data showed a staggering increase in facilities using the eCR interface - from just 187 facilities in 2020, to now over 32,700 in 2024. The CDC now receives real-time data feeds for more than 80% of emergency room visits in the US. This type of use case for FHIR and interoperability should have everyone excited for the future of healthcare - a staggering uptake in usage of an open standards-based reporting interface. They discussed plans to join TEFCA - the so-called ‘network of networks’ for improving health data exchange, and talked about the extension to the US Core Data for Interoperability (USCDI) standard for including data classes related to public health reporting (USCDI+). I left this session inspired, impressed, and yet unprepared for what I would experience before Tuesday was over for me….

As I made my way out of the Government pavilion and started on the long trek back to the exhibit hall for the next session I had saved in my agenda, I received a text message from my Director, Bill Lakenan, that I should make my way over to the startup/investor village at the far end of the exhibit hall for a demonstration from Infor on an electronic Clinical Quality Measurement (eCQM) proof of concept they had built in their Cloverleaf software. Intrigued, I ditched my scheduled session and headed over there, feet aching and heels blistered by this point. I managed to locate Bill and sat down next to him, where the presenters from Infor and Multicare dazzled me with the implementation they had created, leveraging the concept of ontological knowledge graphs and Machine Learning to iterate over massive amounts of patient data to implement an efficient system for stratifying patient clinical data and leveraging eCQMs in measuring clinical quality over a large population - all using FHIR as the underlying data model. Both Bill and myself came away almost dumbfounded at what we’d seen, and were interested to learn more.

After a poor nights’ sleep in the hotel bed, I got up Wednesday and had a coffee and some kind of bread-based breakfast, and headed off to the convention center for another day. Something I’ve learned at conventions like this, is to try to bake in some down time for just meandering around the exhibit hall and meeting people. I had been deliberate in leaving Wednesday fairly light on sessions in my agenda for this purpose, but first - I had a breakfast panel around ONC’s final rule regarding certified Health IT and the requirements for obtaining such. When this final rule arrived in December, it was met with mixed reactions. Ultimately, the HTI-1 rule is meant to place the patient at the center of improving health IT, and requires entities to follow certain rules around information blocking, as well as establishes a date of 1/1/2026 for the adoption of version 3 of the USCDI standard as the baseline, superseding the current version (v1). These changes are important steps on the road to health care interoperability in the US, and we heard from ONC the careful steps they took in writing this rule, as well as the steps they are taking while crafting the next final rule, HTI-2 that will be upcoming.

At this point in my Wednesday, I was in need of more coffee and wanted to take a wander around the exhibit hall, grabbing some swag for my 8-year-old son as I visited each booth. I chatted with the guys at Health Gorilla about TEFCA, visited an old friend at the eClinical Works booth, and made my way over to the Doceree booth to chat with the wonderful Gail Hamilton and the legendary Michael Klotz about FHIR and interoperability, where Michael offered some interesting alternatives to the TEFCA model for sharing data across networks. After this, it was time to make my way over to the Interoperability Showcase to see what was on offer. I was pleasantly surprised to see that the Veteran’s Administration had reserved a massive space, filled with kiosks that demonstrated all of their FHIR and interoperability initiatives. A short jaunt over to the FHIRBall (FHIR business alliance) booth reconnected me with such FHIR luminaries as Rick Geimer, Corey Spears, and Mark Scrimshire. Every time I chat with these fine people, I’m reminded that the HL7 standards community is in good hands.

There is much more to tell, and I will tell it in part 2 of this blog on HIMSS24. Until next time,

Benji Graham

FHIR Evangelist

Bellese Technologies