THINK TANK | Dispatches from the HIMSS 2017 Conference

The Intersect of FHIR, LTPAC and Behavioral Health Data

As I’ve written before, we know there are challenges and opportunities related to care coordination in an ever-evolving landscape. At the annual HIMSS conference, which I attended last month, Foothold Technology had the chance to continue our conversations with partners and leading experts to discuss the issues our customers face when it comes to healthcare IT, behavioral health data, and interoperability. Down below I share notes on a few topics that were keenly relevant at this year’s conference.

As with last year’s HIMSS conference, this year, much of the technical focus was on Fast Healthcare Interoperability Resources (FHIR). ( FHIR is a new standard for quickly standing up health data interoperability between two systems using pre-existing Internet messaging standards rather than healthcare specific tools. It was brought into being through the Argonaut project ( led by John Halamka, who is a kind of deity in the Health Information world. It is a private sector driven standard that doesn’t officially appear in any of the Federal Meaningful Use guidelines or other initiatives, but is often promoted as an important component of interoperability.

One of the FHIR sessions Foothold Technology attended at HIMSS this year included the White House CIO engaging in a lively discussion about how FHIR can speed up the nation’s work towards interoperability. As you might have guessed, discussions of mental health, drug rehabilitation, supportive housing and other behavioral health programs and data were sorely lacking in this conversation. Foothold Technology’s contribution to this meeting was to make sure the White House CIO and the various hospital and EMR executives in the room understood that there is a real problem with any standard that doesn’t account for the social determinants of health as well as the chronic challenges experienced by our dual and multi-diagnosis populations. Foothold Technology was invited to work with a number of stakeholders to help bring behavioral health focused thinking and behavioral health data to this conversation, and we will do so. However, it is important to understand that our community cannot just simply chase every new format, protocol or procedure that crops up. Maybe FHIR really is the future of interoperability. If so, you can be sure we will be there for you. For now, Foothold Technology plans to continue evaluating its work with this standard to assess whether and how this can benefit our community, while continuing to bring the types of Interoperability we know works for our customers today.

LTPAC stands for Long-Term and Post-Acute Care and it is the prime topic of conversation for any and all discussions surrounding behavioral health and non-hospital based care at HIMSS. As observed at this year’s conference, HIMSS is making strides to get a conversation and stakeholder group in place to dedicate time and attention focused on behavioral and mental health services and data. At the HIMSS 2017 Conference, Foothold Technology representatives participated in a roundtable discussion with the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS) to discuss the barriers to interoperability adoption in the LTPAC/behavioral health world. It’s an important topic I’ve discussed before, and one that David Bucciferro, our Senior Advisor, and I echoed again in our discussion. We explained that we’ve observed three general hindrances our community confronts as we move into the world of interoperability.

First, there is the profound problem of a total lack of standards. There are Federal standards, and then there are the different standards in use by each and every Health Home. Currently, even the Delivery System Reform Incentive Payment (DSRIP) programs are creating their own file formats and data requests. When you pile multiple Health Homes and Performing Provider Systems (PPSs) ALL combining different interoperability requirements, on top of community-based mental health organizations — well, you are making it more difficult to usher in success.

Secondly, there is a real problem around incentivizing our community to take action. Why would our community participate in these interoperable projects? Is it to receive money that’s offered or made available? Not really, and money that is available doesn’t always cover the costs required to pay for staff who have the authority and responsibility to ensure data sharing is occurring appropriately. Is it because our community is being forced to comply? Well, sure, behavioral health agencies want to provide the best support possible, but is being told they must comply the best motivation to participate? In reality, the behavioral health community is actually sticking its neck out to get interoperability up and working. In most cases, providers are doing so without the money to really support it, and are often participating without any clear, immediately recognizable benefit for themselves.

Lastly, there is the problem of workflow. What data does the Foothold Technology community want from the physical health world and what kind of behavioral health data does the hospital want from our community? At Foothold Technology we have been asking these questions and facilitating this dialogue for years. Literally.

We can do better.

Our conversations at HIMSS were highly productive; we found the representatives from ONC and CMS to be very receptive to what we were saying. We will continue our efforts to ask agencies like ONC and CMS to look at the world from the perspective of our clients. Hopefully, there will be additional opportunities in the near future to further these conversations and foster a mutual understanding, because in the end, when coordinated care occurs, everybody wins, most of all those we support within our communities.