Why Payers Should Play with FHIR

Or, what’s a FHIR Connectathon, and what’s in it for payers?

This blog introduces participants working on clinical data exchange and value-based care to HL7’s Fast Healthcare Interoperability Resources (FHIR) standard and Connectathon, an event that tests FHIR’s interoperability mettle. Since Connectathon 1 in 2012, the buzz around FHIR has grown exponentially. Word on the street is HL7 has trouble finding hotel conference rooms large enough to fit all attendees! HL7 will host Connectathon 14 in January 2017 in San Antonio.


Go to any HL7 working group meeting and you’ll hear the word FHIR (pronounced ‘fire’) thrown around. FHIR comes pre-packaged with several corny puns. Everyone is really FHIR-ed up—see? HL7 Fast Healthcare Interoperability Resources (HL7 FHIR) offers a fresh perspective on healthcare interoperability. FHIR combines the best features of previous interoperability standards with the latest web architecture standards. FHIR is straightforward for developers to implement and available free-of-charge from HL7.


Interoperability resources are objects or concepts in healthcare, e.g., medications, encounters, orders, and devices, which users can create, read, update, or delete. Resources cover more than clinical concepts, including test results and care team and quality measures. Claims concepts, like explanation of benefits, coverage, and payment notices, are resources, as well as patient, practitioner, and organization. Developers combine resources to form complex data structures. This loose coupling of components makes FHIR flexible, powerful, and maintainable.


Payers will benefit from FHIR’s use in the healthcare community. It is the next generation standard for sharing healthcare data. Implementers can customize FHIR’s core data elements, i.e., extensions. This extensibility is built-in; it doesn’t break the core standard or require significant work.

FHIR’s design has led to significant successes:

  • A large payer reduced development time by six months on a time-critical member-facing project, and saved $500,000 by shifting from custom API development to FHIR.
  • A large provider implemented a chronic disease, SMART-on-FHIR app for patients in less than 100 days.
  • A large vendor built a care coordination application for the VA Care Coordination Challenge, from design concept to working concept, in eight weeks.

As adoption increases, FHIR sets the stage for the exchange of payer and provider data in a standard, open format. It safeguards payer integration access points, reduces long term costs, and eases the burden on implementers across payers, providers and vendors.


Lantana is working with payers to write implementation use cases that describe how payers can use FHIR now to simplify and improve existing processes. In the use cases, participants will:

  • Extract EHR data for quality measure calculations.
  • Exchange electronic claims attachments.
  • Exchange Admission, Discharge, and Transfer data.
  • Populate patient health record (PHR) data for the payer’s member portal and mobile applications.

FHIR boasts a rapid specification development timeline; and the Connectathons are a big part of the process. A Connectathon is a two-day event where implementers meet to develop and test FHIR software. If you aren’t sure whether FHIR is worth the investment, the Connectathon will convince you. It provides a taste of that rapid development methodology. Sharing data in a few hours speaks louder than anything we might say.


Each Connectathon is divided into ‘tracks’. Tracks are based on individual healthcare use cases, like patient data exchange, clinical decision support, or claim processing. Track proposals explain the application of FHIR, the test scenarios, and participation. Connectathon tracks are your chance to test the standard, and write software to solve the scenario. In each track, you will create, update, retrieve, and delete data on a FHIR server via an out-of-the-box application (e.g., Postman) or an application you create. Writing your own software and interacting with the FHIR server is the essence of the Connectathon. The track adds context around the application.


New participants to a Connectathon should:

  • Review the Connectathon 14 wiki page (or just Google FHIR Connectathon 14)
  • Familiarize yourself with the tracks you will attend. Each track has a sub-page describing the roles, scenarios, etc., which are important to understand before you arrive.
    • Open the Google Docs spreadsheet link in the Registered Participants section of the wiki page.
    • Enter your name in the Participants tab and an X in the column for each track/role you intend to join.
  • Set goals, and create a plan to accomplish them, because the Connectathon is only 1.5 days.

The Connectathon 14 wiki page lists the current tracks. The following tracks are most relevant for payer participants:

  • Attachments: Uses FHIR to exchange electronic attachments between providers and payers for claims processing and other interactions. The track includes scenarios to test solicited attachments, unsolicited attachments, and prior authorization use cases.
  • C-CDA on FHIR: Supports exchange of clinical documents using FHIR. Track is based on a project to port the Consolidated Clinical Document Architecture (C-CDA) implementation guide to FHIR syntax. Scenarios focus on creating and rendering documents, and extracting resources from received documents.
  • CDS-Hooks: Develop a Clinical Decision Support (CDS) framework that integrates into an existing EHR. The scenarios implement decision support pop ups for patient safety, medication and drug interactions, prescription suggestions, etc.
  • Clinical Reasoning: Test resources designed for clinical quality, decision support, order sets, and practice guidelines. Scenarios share a chemotherapy order template, report Zika virus data, and extract patient data.
  • Financial: Processes claims with the FHIR financial and payer resources. Participants submit, and receive responses for, claims, eligibility requests, and pre-authorization.
  • Patient: Provides a friendly introduction to FHIR by focusing on the Patient resource, one of the most tested resources in FHIR. Participants create, update, delete, exchange, and test the Patient resource.
  • US Core (formerly called Data Access Framework Core): Implement the ONC 2015 Common Clinical Data Set requirements in FHIR. The track tests US Core artifacts and queries to retrieve patients, allergies, immunizations, procedures, etc.

And that’s a wrap—see you in sunny San Antonio! Don’t forget to book your hotel as soon as possible, and register for Connectathon 14. You can read the full details on what happens at a Connectathon in part 2 of this blog.