How the Cures Act + CDS + New Application Programming Interfaces like CART will Help Transform Electronic Healthcare Information

It’s an exciting time to work in clinical informatics. 

Thanks to ONC’s Cures Act Final Rule “Cures Act” which was signed into law December of 2016 by President Barack Obama, we have been gifted with rapidly growing data accessibility and interoperability within the healthcare sector. The time is ripe to advance Electronic Health Information (EHI) that utilizes novel applications and expands the scope of EHI solutions.  

The Cures Act seeks to help ease regulatory burdens associated with the use of Electronic Health Record (EHR) systems (primarily EPIC and ORACLE CERNER, that combined represent nearly 60% of the U.S. market), and adopting the standardized format known as Fast Healthcare Interoperability Resources (FHIR) based Application Programming Interfaces (API’s). These applications are designed  to leverage data for seamless and secure exchange, and use of improved health Information Technology (IT). FHIR solutions are built from “Resources”, which are a set of modular, standardized components. These resources are industry standard and can easily be assembled into working API systems that solve real world clinical and administrative problems and at a fraction of the price versus existing alternatives. FHIR can be used in a wide variety of contexts including mobile phone apps, cloud server communications with EHR’s and patient information databases, and much more.

The U.S. Department of Health and Human Services (HHS) finalized the Cures Act rules in March 2020, which ushered in the next phase for the Cures Act. HHS called the rules “the most extensive healthcare data sharing policies the federal government has implemented.” And part of the Cures Act includes decreasing information blocking, in which EHI should be accessible and deadlines are upcoming. Recently, on December 31st of 2022, the HL7 FHIR API capability and other criteria was supposed to be made available by EHR’s and hospitals and in one year on December 31st, 2023, EHI export capability must be made available or fines will prevail. This next year of open accessibility is the time for many system optimizations and it will be exciting to see what develops.

The hope of computerizing healthcare is that better applications will lead to better patient care. One way to improve care is through minimizing unnecessary resource utilization and non-value-added treatment. Enhanced situational awareness, and documentation of medical necessity, through Clinical Decision Support (CDS) tools, may contribute to decreased errors. Clinical Decision Support (CDS) has been defined as “a process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery.” CDS aims to augment clinical work. It’s designed to alert/trigger the clinician out of an autopilot mode and have them consider potentially life-saving, better, alternative ways of care work. CDS improvements will help reduce waste and improve care outcomes by making suggestions improving decision support and safer with less waste. The best CDS apps provide just-in-time prompts to the clinician, integrated into the natural workflow and with minimal disruptions.

The U.S. Department of Health and Human Services reported in a 2018 study “that 1 in 4 Medicare patients experienced harm (43% due to medication errors), and that nearly half of these were deemed preventable.” Quality is also impacted by waste. A 2013 report by the Institute of Medicine “estimated that unnecessary care adds $210 billion to annual US healthcare.” It has been estimated that 30% of inpatient antimicrobial therapy, 26% of advanced imaging, and 12% of acute percutaneous coronary interventions are unnecessary or inappropriate. 

The time for Artificial Intelligence (AI) preferably built by experienced caregivers and physician advisors in best practices is now. Hospitals are geared up and as of 2017, 94% of hospitals used EHR data to guide clinical practice, primarily to support quality improvement, monitor patient safety, and measure organization performance. CDS innovation to foster and empower care ecosystems with new applications providing smarter choices is here. The global market for CDS systems was valued at $1.4 billion in 2021 and estimated to reach a market size of $3.1 billion by 2030.

This is why our experienced Physician Advisors created the CART (Continuous Actionable Resource Triggers) application solution. Much like FHIR itself, CART is focused on solving real world clinical and administrative problems at a fraction of the time, and price of alternative solutions. Designed using the logic and experience collected from well-respected Physician Advisors and Hospitalist over the last 30 years, SAPHUR (“say-fer”) Healthcare Solutions CART CDS trigger tool is a concurrent application catching opportunities in real-time and 24/7. CART allows modifiable triggering tools to enhance clinical situational awareness, ultimately catching and reducing waste while creating safer + better patient care outcomes. 

It’s truly an exciting time to be in clinical informatics!