Case Study

As health care records become increasingly digitized, it’s crucial for electronic health records (EHRs) to be readily available and understandable by health care workers and other key stakeholders. However, health care entities such as hospitals or clinics may store EHRs in different data formats, posing problems for interoperability, clinical decision-making, and cross-organizational collaboration. Fast Healthcare Interoperability Resources (FHIR) is a standard developed by Health Level Seven International (HL7) for exchanging health care data that aims to remedy this issue. FHIR offers a standardized format for data-sharing, regardless of how individual health care organizations store data, and it’s flexible enough to serve a variety of use cases across health care. 

As FHIR gains momentum across the health ecosystem, Nava is investing deeply in building our FHIR capabilities, talent, and community. Below is one case study outlining how we helped the Centers for Medicare & Medicaid Services (CMS) advance health care data interoperability with FHIR. 

Using API technology to provide Medicare enrollees with exceptional care 

To ensure that Medicare enrollees receive high-quality care, the Centers for Medicare & Medicaid Services (CMS) has been leading efforts to give enrollees, their providers, and select third-party applications secure access to health care data. As part of this effort, CMS partnered with Nava to help design, develop, and operate their Blue Button 2.0 (BB2.0) application programming interface (API) and associated FHIR database.

BB2.0 is a FHIR-enabled API that delivers claims data for over 60 million Medicare enrollees. The API streamlines data access for third-party applications, doctors, research programs, and others, ultimately giving Medicare enrollees more options for care and better control over their claims data. It also helps software developers build applications that improve health outcomes for Medicare enrollees.

We have two teams working with CMS on this effort. The first is helping maintain a FHIR database that feeds BB2.0 and other CMS claims data APIs. Our team is helping CMS gather and process data from different sources then convert it to FHIR. This helps ensure compliance and interoperability with other FHIR-based systems.

Our other team is partnering with CMS to maintain and operate BB2.0. This means addressing bugs, helping developers with support requests, onboarding new organizations onto the API, enhancing data fields, and gathering feedback from developers on how CMS can improve the API. Designers on this team are also interviewing Medicare enrollees to better understand how the API can meet their needs.

Outcomes

By partnering with CMS to maintain and operate BB2.0, we’re helping the agency work toward a state of interoperability between CMS systems, health care providers, and third-party applications. This is important because it empowers Medicare enrollees and their health care partners with data to make informed decisions about their health journeys. Here are a few use cases that demonstrate the API’s impact:

Personal health data aggregators

Research suggests that 30% of Medicare enrollees have several chronic conditions and see over five health care providers annually. Applications that aggregate health data using BB2.0 can enable Medicare enrollees to see all of their health care information in one place, helping to coordinate care among several providers.

Insurance plan finders

Insurance plan finder tools can use BB2.0 to recommend insurance plan options based on a Medicare enrollee’s health history and needs. These tools can also use BB2.0 to help Medicare enrollees estimate costs with each plan and check if their current providers are in-network.

Clinical research studies

People who participate in research studies often have to fill out lengthy forms or continuously submit data. BB2.0 allows Medicare enrollees to authorize researchers to automatically pull their claims data, alleviating the burden of manual data entry.

Health record sharing

Medicare enrollees can use BB2.0 to easily share their health data with providers, pharmacies, caregivers, and more. BB2.0 can integrate directly with EHRs, enabling enrollees to share information like current medications, lab results, and medical imaging with providers. This gives everyone involved a holistic understanding of the enrollee’s health journey and ultimately promotes better health outcomes.

Digital Medicare insurance cards

We’re helping CMS build digital Medicare insurance cards that will give enrollees and their providers real-time access to coverage information. CMS will use BB2.0 to populate the information on these insurance cards.

Conclusion

FHIR is quickly becoming the health care industry standard for data interoperability. That’s why we’re partnering with federal agencies like CMS to invest in our FHIR capabilities and work toward an interoperable health care ecosystem. By helping CMS empower Medicare enrollees and their caretakers with data, we’re contributing to better health care outcomes across the board. 

This report was prepared by Nava. The views expressed are those of the authors and do not represent an official statement, policy, or endorsement by the Centers for Medicare & Medicaid Services.