This blog was co-authored by Angus McAllister, Product Owner of Open Source Healthcare Interoperability at AWS, and Art Huston, Engineering Manager at Abacus Insights.
In March 2019, the US Centers for Medicaid and Medicare Services published the CMS Interoperability and Patient Access Final Rule, requiring healthcare providers and payors to ensure patients have access to their medical and claims data. This implements a number of provisions of the 21st Century Cures Act and defines technical standards that these organizations must comply with, including HL7’s FHIR (Fast Healthcare Interoperability Resources). The majority of US providers and payors are subject to this, posing an industry-wide challenge.
To achieve compliance, organizations may build these standards into their systems themselves if they have the in-house capability, purchase new or upgraded software that implements these standards, or commission system integrators to do this for them. Because this needs to be done by a great many organizations, AWS created the FHIR Works on AWS toolkit, announced in August 2020, to reduce the undifferentiated heavy lifting required. FHIR Works on AWS is an AWS Solutions Implementation with an open source software toolkit that can be used to create a FHIR interface over existing healthcare applications and data. This provides a set of essential components necessary for complying with the final rule that AWS customers and APN partners can use to accelerate building their own solutions.
AWS partner Abacus Insights, who offers a healthcare-specific Data Management and Analytics Enablement platform, wanted to build a product that would not only enable their healthcare payor customers to comply with the CMS final rule, but also enable them to gain previously unavailable insights into their data. After evaluating several possible approaches, from creating it from scratch through incorporating third-party products to integrating various managed services, they settled on using FHIR Works on AWS as the foundation. This most closely fit their vision of what they needed to achieve for their customers: a solution tailored to their specific requirements for security, deployment automation and streamlined operations, but without the overhead of having to re-create the FHIR interface and all the associated processing logic. Abacus’ solution enables its customers to not only comply with the CMS Interoperability and Patient Access Final Rule, but also excel at operating and meeting the ongoing high security demands of managing PII & PHI data. Abacus has now implemented this solution with three Healthcare Payor customers, going live on July 1, 2021. They will be able to ingest data from a variety of data sources (medical claims, pharmacy, lab, encounters), make it available in FHIR servers in compliance with the CARIN and DaVinci implementation guides, and allow third-party apps to access it using the SMART on FHIR Smart App Launch protocol.
When Abacus first encountered the FHIR Works on AWS toolkit, it had not yet been released. But they and AWS saw the potential in establishing a joint engineering collaboration—not only to achieve their respective goals, but also to enrich the healthcare interoperability community by contributing open source software of real value.
As a partner with AWS Enterprise Support, Abacus had access to a dedicated Technical Account Manager, who proposed and helped facilitate that collaboration. This has involved weekly cadence calls and other near real-time communication between both companies’ engineering teams for their respective products, where they share information and progress, and collaborate on design and development activities. As the collaboration progressed, it became increasingly clear that goals were well aligned and that both organizations’ teams brought complementary strengths. A strong focus was placed on providing functionality for customers to comply with the CMS final rule. Abacus provided real-world challenges relating to the kind of data they process, together with insights on interpreting the specifications for the various FHIR Implementation Guides that needed to be supported (including SMART on FHIR, CARIN Blue Button and Da Vinci Payer Data Exchange) and several contributions to the codebase itself. Especially valuable was the integration of the Auth0 Identity Provider (also an AWS partner), which saved the AWS team around six weeks of development effort. AWS, for its part, provided ongoing project and technical leadership, as well as the main body of code that Abacus’ complemented.
After seven months of working closely together, both teams felt that the collaboration was resoundingly successful. As a result of incorporating the FHIR Works on AWS toolkit into their own product offering, Abacus has been able to deliver an integrated, cloud native, CMS-compliant interoperability solution that complements their broader data management product offering. It has also enabled Abacus to benefit from ongoing enhancements to and bugfixes for the toolkit, ensuring that their solution is built on top of an open source product that is well supported and maintained by the AWS team. This not only allows Abacus customers to stay compliant with CMS regulations, but lays the foundation for future analytics and operational use cases that could benefit from FHIR-based data exchange.
Art Huston, Software Engineering Manager at Abacus, said, “The collaboration with the FHIR Works on AWS team has yielded tremendous business value to Abacus by helping accelerate our build of a CMS Final Rule compliant FHIR server, while benefiting from the scalability, flexibility and security that can be achieved on the AWS Cloud.”
In addition, Abacus’ inputs and code contributions have accelerated the toolkit’s roadmap and delivered real value to the open source healthcare interoperability community. The collaboration also helped the AWS team avoid unnecessary pitfalls in implementing the specifications.
Visit Abacus Insights’ website to learn more about their vision for Better Care through Better Data.