Regulators Increase Pressure on Data Interoperability
Healthcare providers are facing a potential compliance crisis due to updated Office of the National Coordinator (ONC) rules on information blocking. These federal mandates, which require seamless data exchange and patient access, are pushing health systems to adopt standards like HL7 FHIR to ensure data liquidity. New regulations also impose transparency requirements for provider directories, adding to the compliance burden for organizations.
- The information blocking rules stem from the 21st Century Cures Act, which was signed into law in 2016 to increase interoperability and patient data access. The compliance date for these regulations was April 5, 2021, and as of October 6, 2022, the definition of electronic health information (EHI) that must be shared expanded beyond a core set of clinical data to include all EHI in a designated record set. - HL7 FHIR (Fast Healthcare Interoperability Resources) is a modern standard that uses web-based technology to allow different health IT systems, including Epic, to securely exchange data in real-time. Unlike older, more complex standards like HL7v2, FHIR organizes data into modular "resources"—such as patient demographics, lab results, or medications—making data more granular and easier for applications to access. - For an ICU nurse to transition into informatics, employers typically require an active RN license and a BSN, with many preferring a master's degree in health informatics. The American Nurses Credentialing Center (ANCC) offers the Informatics Nursing Certification (NI-BC), which requires an RN license, a BSN, two years of full-time nursing experience, and specific hours in informatics practice or coursework. - Artificial intelligence is being used in critical care to improve clinical decision-making by rapidly analyzing large datasets to predict patient deterioration, such as sepsis or organ failure, and to help manage mechanical ventilation. Studies have shown AI can improve the early detection of critical conditions by 20-40% and reduce ICU stays. - A common complaint from ICU nurses about EHRs is the "information overload" caused by poorly designed interfaces with redundant data fields, which can increase documentation time. A recent report found that nearly one-third of nurses experiencing burnout cited their EHR as a contributing factor, with 40% of those nurses likely to leave their organization within two years. - Epic's support for the FHIR standard is demonstrated through its "Epic on FHIR" platform, which provides a suite of FHIR-based APIs. This allows third-party applications to securely connect with the Epic EHR, facilitating a more open healthcare ecosystem and enabling innovations like patient-facing mobile apps. - An alternative pathway into nursing informatics without a formal informatics degree is to leverage clinical expertise by becoming a Subject Matter Expert (SME) on a technology team. In this role, an experienced ICU nurse would provide critical input on how software should be designed to work effectively in a real-world clinical setting. - The information blocking rule includes eight specific exceptions that define practices that are not considered information blocking. These exceptions cover reasonable and necessary activities, such as those related to preventing patient harm, protecting patient privacy, and addressing the infeasibility of a data request.
