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The Business of Health Data

Health Gorilla's Guide to Healthcare Interoperability Resources (FHIR)

Health Gorilla’s pragmatic approach to supporting national healthcare data exchange and interoperability

All businesses use data, but not every business is a data business.

Some of the largest and most recognizable brands today, including Google, Yelp, and ZoomInfo, gather, refine, and use unique data as their core product offering. While data businesses all acquire and utilize data as their primary commodity, their collection processes and revenue strategies vary significantly. Once raw data is collected, companies must dedicate significant resources and upfront investments to add utility and scalability to their offering and take it a step beyond a minimum viable corpus.

All this adds up to slow beginnings and growth rates, making the financing of early-stage data businesses challenging. But a slow start is not always a bad thing. Gathering and modifying data into an actionable format that can be widely used is a very durable business model. Once the target audience has been educated and is familiar with the benefits of a particular data set, data businesses are primed to see consistent growth over time.

As the cost of data declines and its value increases, sales cycle times decrease, and economies of scale begin to show. Over time the data goes from optional to essential, and companies start to play “follow the leader” when they see competitors have an advantage by tapping into a particular set of data.

Once data businesses have reached this point, they can unlock new channels of data acquisition, including customer contribution, which, when paired with data quality loops, allow data businesses to leverage data that’s been contributed and verified by their customers.

Reaching this point is pivotal for data businesses and a strong indicator that they will continue to see consistent growth.

Health Data – Where We are Today and Where We are Going

While most successful data businesses experience slow growth rates and high up-front costs, data businesses in the healthcare industry have additional hurdles to overcome. Since the inception of electronic health records (EHRs), health data has been fragmented, disparate, and unstandardized.

Data in healthcare stems from many sources and comes in various formats. EHRs, labs, insurance carriers, pharmacies, and many other stakeholders all use multiple systems to access and share data.

The industry needed years of work and significant innovation before any data business could be successful in the healthcare space. Below is a summary of major milestones that enabled data businesses to succeed and nationwide interoperability to become a reality.

The HITECH Act

One of the first breakthroughs came in 2009 with the passing of the HITECH Act, which provided funding for states and their state-designated entities to support statewide health information exchange (HIE) services. The development of state and regional HIEs brought tremendous growth to healthcare interoperability and electronic health information exchange.

In addition to facilitating clinical data exchanges, they also aggregate disparate EHR data, making it more reliable and actionable, and supply provider services with advanced analytics that contribute to social determinants of health.

Fast Healthcare Interoperability Resources (FHIR)

Another milestone for the healthcare community came in 2012 when Graham Grieve and a small team working alongside him at HL7 began developing the Fast Healthcare Interoperability Resources (FHIR) framework. FHIR was explicitly created to unify disparate records and allow the healthcare community to seamlessly share data regardless of how local EHRs represent or store their information.

Today FHIR is used in thousands of applications that support patients and the healthcare industry. It has been adopted by many health systems, some of the most prominent EHR vendors, and companies in the private sector who are disrupting the industry with new and innovative technologies.

The success of FHIR and HIEs sparked a few key organizations, including CommonWell Health Alliance, Carequality, and eHealth Exchange, to explore interoperability at the national level. They each began developing frameworks to facilitate secure exchanges between networks and quickly became the three largest public HINs in the country. Today, they provide connections and/or memberships to organizations that satisfy their permitted exchange purposes and facilitate data exchanges across the country.

That said, there was still room for improvement in national data exchanges. Today, for digital health companies, payers, hospitals, and other healthcare providers to have complete access to the nation's clinical data, they need to build one-off connections with each national HIE highlighted above, which can be costly, time-consuming, and resource intensive.

21st Century Cures Act

The most recent innovation, and quite possibly the most meaningful, came in 2016 when the Obama administration signed the 21st Century Cures Act, which called on the Office of the National Coordinator for Health Information Technology (ONC) to "develop or support the trusted exchange framework, including a common agreement among health information networks nationally."

This was followed by the development of the Trusted Exchange Framework and Common Agreement (TEFCA), which was created to establish universal interoperability standards across the country between Health Information Networks (HINs). The ONC has three primary goals attached to TEFCA:

  1. Establish a universal policy and technical floor for nationwide interoperability.
  2. Simplify connectivity for organizations to securely exchange information to improve patient care, enhance the welfare of populations, and generate healthcare value.
  3. Enable individuals to gather their healthcare information.

TEFCA version 1, released on January 18, 2022, will also establish our country's first Qualified Health Information Networks (QHINs), the entities responsible for facilitating the national exchange of data. The ONC has also released a FHIR Roadmap for TEFCA Exchange, and has stated that, “The industry’s embrace of FHIR makes it imperative that TEFCA include a deliberate strategy to add FHIR- based exchange.”

Our platform at Health Gorilla was created through the lens of TEFCA and leverages FHIR's modern standards. We believe that pairing the two has the potential to truly change the data sharing landscape in healthcare.

A History of Health Gorilla and Our Data Aggregation Methods

The growth scenario for data businesses outlined at the beginning of this piece was certainly the case for Health Gorilla. Founded in 2014, Health Gorilla started as a marketplace and solution for lab and diagnostic vendors. After a year in the lab and diagnostic space, it became clear that the healthcare industry was desperate for a secure and reliable solution that provided the healthcare ecosystem with a holistic view of patient medical records. So, our team entered the market of query exchange and began building a massive data platform to support secure data exchanges in 2015.

After three years of forming partnerships and demonstrating the actual value of our data, we secured our first round of funding. This initial round allowed us to scale our platform, introduce our FHIR-based APIs, and increase the overall value of our data.

Four years later, Health Gorilla has raised $80 million and is a leading Health Information Network with a national Health Interoperability Platform, compliant with R4 profiles, that allows the entire healthcare ecosystem to securely share and access clinical data.

Today, we operate the largest Health Information Network in the United States and the only statewide HIE in Puerto Rico. We have memberships and connections to Carequality, CommonWell, and eHealth Exchange and allow our customers to access data from a network of over 120,000 care sites and hundreds of labs through our Health Interoperability Platform. Our platform accepts over 120 data formats and includes a secure gateway to ensure that only customers with a permitted treatment use case can query patient records. Once a data query is initiated, the requested information is run through our processing engine, which normalizes, deduplicates, and consolidates the data into an actionable format. The data is then securely stored in our repository and delivered to the customer who initiated the query.

We have also implemented bi-directional exchange agreements similar to the customer contribution and data quality loops discussed above. This ensures that updated records are returned to us, guaranteeing that the next querier has the most up-to-date information on a shared patient.

What’s Next for Health Gorilla?

Later this year, Health Gorilla will be pursuing a QHIN designation under TEFCA. As a designated QHIN, we will continue to offer our well-known interoperability solutions but also expand our services as we begin facilitating data exchanges for new purposes. This will allow us to provide our services to a larger pool of the healthcare community and increase how current and future clients can leverage our solutions.

As one of the only known commercial entities applying for the QHIN designation, Health Gorilla will act as a liaison between the healthcare market and governing bodies. We believe that pairing the TEFCA requirements with our close relationship to the market will add a tremendous amount of value. By connecting with a broader scope of organizations, we will be able to develop more efficient data flows, expand our services, and create more innovative lines of business, all while reducing the intricacies of exchange.

Overall, the QHIN designation will increase our ability to facilitate access to health data across the country and allow us to deliver additional value to our participants and subparticipants.

Ready to Expand Your Access to Clinical Data?

If you are part of a healthcare organization and interested in expanding the data available to your physicians or patients, the Health Gorilla team is here to help. We offer a comprehensive implementation plan which includes a dedicated implementation specialist and solutions architect who will work with you to configure the connection between our suite of APIs and your application. We tailor our implementation to your organization's unique clinical data workflows and provide access to the Health Gorilla development sandbox. Our team of experts is available to answer any questions through the testing and validation period. If you have any additional questions or are interested in exploring a partnership with Health Gorilla, please contact us.