Skip to content
Effectuez une recherche pour en savoir plus sur les produits et solutions InterSystems, les offres d'emploi, etc.

You’ve Implemented FHIR, What’s Next

Leveraging FHIR for Payers

doctor entering patient information on her laptop in an exam room

The implementation of the CMS Interoperability rule (9115-F) required payers to use HL7® FHIR® as a way to share clinical, claims and pharmacy data with their members via third-party apps. It also required them to share provider directory data so that other organizations can make use of that data.

This transformation process involved significant time and resources, but once completed, it presents an opportunity for payers to leverage their investment in FHIR infrastructure and aggregated data beyond just regulatory compliance. By exploring FHIR’s capabilities, payers can:

  • Enhance member engagement using third-party apps connecting to the FHIR repository.
  • Leverage the assets of the HL7 Da Vinci project to strengthen provider relationships through enhanced data sharing and improve value-based care processes. For example, reducing the burden of data capture for quality measures and automating the thorny problem of prior authorization.
  • Improve operational efficiencies by using aggregated data to serve other internal applications such as ongoing performance measurement and reporting.
  • Use the data aggregated through FHIR APIs to enable innovation such as improved risk adjustment or infrastructure modernization.

The collaborative Da Vinci project continues to develop, test, and deploy FHIR-based solutions to solve for some of the most pressing use cases for the move to value-based care. For example, Data Exchange for Quality Measures (DEQM) provides a FHIR-based mechanism for exchanging data for quality measures and to identify gaps in care.

Gartner’s recent report Clinical Data Integration Capabilities and Sourcing Recommendations for U.S. Healthcare Payers, states that CIOs need to, “Futureproof your clinical data integration (CDI) strategy by incorporating Fast Healthcare Interoperability Resources (FHIR) API adoption and proliferation scenarios”¹. Furthermore, through new rulemaking like the CMS-0057P Advancing Interoperability and Improving Prior Authorization Processes, CMS has made it clear that FHIR will continue to be part of the regulatory roadmap.

Business Transformation Manager
BCBS Arkansas

Not every organization that implemented and complied with 9115-F, will benefit fully from the new infrastructure they built. There were three types of organizational approaches to the rule:

  • Those that did the bare minimum to “check the box” by the deadline. Many of these chose a short-term partner to expedite their immediate need.
  • Those who saw the strategic opportunity, and made incremental investments with a long-term partner. This group recognized the need for future expansion, but chose not to create a detailed plan.
  • Those who built out comprehensive shared data and FHIR infrastructure with a long-term partner and plan, for example, organizations like MVP Health Care.

When MVP Health Care was looking for a vendor to help them implement the CMS-9115 regulations, they wanted a partner that would help them achieve their larger goals – to improve their HEDIS scores and enhance their member experience. No one can navigate the journey toward interoperability and actionable insights alone. When MVP resolved to invest in building a data-driven, member-centric organization, Dominick Bizzarro, Chief Growth Officer, knew his next move. “We’re all in,” he recalls. “Let’s work with a partner that recognized we’re going to be in a relationship — a long-term relationship.”

Next Steps

Which type of organization are you, and have you planned your next steps in this innovation journey? How are you going to differentiate your organization with the assets you’ve deployed? Will your current partner get you where you need to go?

If you’re not sure, consider working with a partner that sees this as a journey. One that can expand existing capabilities to support your future business requirements, your clinical data strategy and future use cases and is committed to the new regulatory requirements. Consider InterSystems.

InterSystems can help you craft and realize your future strategy for innovating with better data and better workflow. Here’s why:

  • We have been members of the HL7 Da Vinci Project for the past 4 years and have experience with the implementation guides.

  • We have years of experience with healthcare standards and have supported FHIR since its earliest versions.

  • As experts in interoperability, we know how to aggregate and normalize data into a unified member view.

  • We put our customers success first. InterSystems customers rated our support with 100% satisfaction over the past year.

In an IDC Report², InterSystems HealthShare is listed as a vendor that has reacted to the CMS mandate in their move toward customer-360 platforms that satisfy enterprise need and recognize that data homogenization and curation was a necessary component of payer infrastructure. This curation is also a requirement for legitimate interoperability.

To learn how InterSystems can help you leverage FHIR to streamline measurement, improve operational efficiencies, and enhance quality and member engagement, visit InterSystems.com/Payers


1 - Gartner “Clinical Data Integration Capabilities and Sourcing Recommendations for
US Healthcare Payers”, Mandi Bishop, April 26, 2021, refreshed September 12, 2022

2- Eight Drivers for Payer Interoperability Implementation, Now!, IDC #US46539920, Jeff Rivkin, June 2020


Autres Ressources Que vous Pourriez Apprécier

27 Aug 2025
Supply Chain
Gagnez en visibilité intelligente sur votre supply chain Les chaînes d’approvisionnement font face à des disruptions constantes : événements météorologiques, tensions géopolitiques, pénuries de main-d’œuvre ou encore problèmes de capacité. L’intelligence décisionnelle peut aider en exploitant l’IA, le machine learning et les simulations pour prédire les résultats, évaluer différents scénarios et recommander la meilleure action afin de surmonter ces perturbations.
25 Aug 2025
InterSystems IRIS for Health™ en tant que référentiel et entrepôt de données indépendant
Un référentiel de données cliniques permet le traitement des données de santé en dehors du système de dossiers patients informatisés (DPI). Téléchargez le livre blanc pour en savoir plus.
25 Aug 2025
Découvrez MayVilleHop, une plateforme collaborative de santé co-construite par la ville et l'hôpital en Mayenne. Elle facilite la communication entre professionnels, accélère la prise en charge des patients, et soutient la prévention à l’échelle territoriale.
25 Aug 2025
Congrès FHF interrégional
Lors du Congrès @FHF Bretagne et Pays de la Loire, Sebastien Tréguenard, Directeur du CH de Laval, a rappelé combien il est crucial de repenser l'organisation des soins pour répondre aux besoins de santé de la population dans son ensemble. L'enjeu ? Coordonner les efforts des hôpitaux et des médecins de ville pour garantir un accès équitable et fluide aux soins, peu importe le parcours de chaque patient.
25 Aug 2025
Congrès FHF interrégional
Cette table ronde, qui s'est tenue le 27 septembre 2024 lors du congrès FHF interrégional Bretagne Pays de la Loire, aborde les enjeux de l'IA et de l'innovation dans les services numériques destinés à améliorer l'expérience des usagers dans le secteur de la santé.
25 Aug 2025
SantExpo 2025
Dans cette vidéo, explorez comment le portail patient révolutionne les admissions à l’hôpital grâce à la dématérialisation des démarches administratives, la personnalisation des processus et l’usage de QR codes pour un passage rapide et sans friction.
25 Aug 2025
SantExpo 2025
Retour d’expérience de l’Hôpital Américain de Paris et démonstration d'InterSystems IntelliCare, un DPI intégrant l’IA dans les workflows métiers : cas d’usage et méthode.
25 Aug 2025
SantExpo 2025
Cette présentation met en avant les fonctionnalités avancées du serveur FHIR d'InterSystems.
25 Aug 2025
SantExpo 2025
Cette démonstration présentera un transfert de dossier patient entre deux hôpitaux en s’appuyant sur l’International Patient Summary (IPS).
25 Aug 2025
SantExpo 2025
InterSystems TrakCare évolue. Avec l’IA intégrée dans ses workflows, découvrez InterSystems IntelliCare : un dossier patient nouvelle génération qui simplifie le quotidien des professionnels de santé et leur redonne du temps patient.

Passez à l'étape suivante

Nous serions ravis d'échanger avec vous. Remplissez les champs suivants et nous vous recontacterons.
*Champs obligatoires
*Champs obligatoires
*Champs obligatoires
*Champs obligatoires
** En cochant cette case, vous consentez à recevoir des actualités, des mises à jour et toute autre information à objectif marketing liés aux produits et événements actuels et futurs d'InterSystems. En outre, vous consentez à ce que vos coordonnées professionnelles soient saisies dans notre solution CRM hébergée aux États-Unis, mais conservées conformément aux lois applicables en matière de protection des données.