Using FHIR as a Competitive Advantage to Expand Referral Networks
Healthcare has a physician burnout problem. Healthcare has a patient satisfaction problem. Healthcare has a cost problem.
These are common refrains in healthcare today, but what single factor is at the center of each of these problems? Access to data.
Lack of access to data leads to delays in care, redundant data entry, repetitive procedures, and causes financial hardship for patients and providers alike. As a result, costs to healthcare organizations and their patients have skyrocketed.
Data sharing in healthcare has been limited by several factors: competition-fueled inertia, resilient paper-based workflows, systems cost, and (most acutely) a lack of standards for exchanging healthcare information. To understand why first requires a little historical context.
Why Healthcare Data Sharing is Still Limited
Historically, healthcare providers have been the keepers of patient health data and — much like a series of physical filing cabinets — have kept it locked off from the rest of the world. In some cases, the data was cordoned off from the wider healthcare ecosystem as an attempt to gain competitive advantage by putting a fence around the provider’s patient population. But even if competitive advantage was not the goal, the systems of the day were not designed to be interoperable and share data.
Electronic Health Records (EHRs) began to emerge in the late 1960s with the launch of Meditech, followed in time by a host of other EHR vendors including Epic, Cerner, HBOC, Eclipsys, SMS, CPSI, and Healthcare Management Systems. They launched in a pre-internet world where documents were shared through the mail, images were shared as hard copy prints, and music was shared on cassette tapes.
These early EHR systems were built around a single, monolithic on-premise database written in proprietary languages, like MUMPS. Transitioning discrete data from paper to electronic records, and normalizing it to be stored locally, was a huge achievement.
By the 1980s Medicare, Medicaid, and commercial payers began to require patient demographics and coding data to feed their reimbursement system. This started the era of Electronic Data Exchange (EDI).
The primary function of EHRs remained focused on Patient Accounting and Revenue Cycle, with clinical integration largely limited to the exchange of lab and pharmacy orders and results. However, this changed in 2009 when the Health Information Technology for Economic and Clinical Health (HITECH) Act was signed into law.
Prior to HITECH, EHRs — and hospitals themselves — saw no economic motivation to exchange clinical data with competing vendors or health systems. HITECH provided the financial incentive, via one-time reimbursement, to encourage EHRs and their customers to implement clinical documentation systems that would allow patient data to be shared across EHRs and health systems.
“The nice thing about standards is that there are so many to choose from.” Andrew S. Tanenbaum
How FHIR Helps Address the Data Sharing Dilemma
First came HL7…
When data is standardized into a format that is normalized into consistent nomenclature across all stakeholders, then all stakeholders benefit — including the ultimate stakeholder, the patient. Which is why Myndshft has chosen to design our data integration around the Fast Healthcare Interoperability Resources (“FHIR”) integration standard. FHIR is an open-source unified application programming interface (API) architecture that is the new standard upon which healthcare integration is being built.
While health level seven international (HL7) — specifically v2.x — and proprietary APIs still have their usefulness, HL7 is susceptible to a wide range of variation in the implementation of the standard, and proprietary APIs require significant coding or crosswalking in order for disparate systems to speak with each other. With FHIR, each message type (e.g. a “resource”) is modularized and able to be passed independently with minimal variation, which allows for a faster and more succinct implementation.
You may be wondering why the move to FHIR as an interoperability standard is important in the world of post-acute, alternate sites of care.
In an environment where the flexibility to directly integrate with the sources of orders, requisitions, and referrals — hospitals and physician offices — provides a competitive advantage, post-acute, alternate site providers such as labs, specialty pharmacies, home infusion, and imaging centers stand to improve top-line revenues by incorporating a flexible integration standard that is easily administered.
Post-acute, alternate site providers in these spaces also tend to have fewer internal resources for complex Health IT integrations; leveraging systems that use the FHIR standard lessen the resource burden on those resources. Reduced resource burden results in lower integration costs, improved speed to market, and more satisfied customers.
If we consider the administrative documentation required to submit a prior authorization with an order for a genetic test, specialty medication, or referral for an infusion of a biological medication, it becomes apparent that ordering providers can reduce the documentation burden through direct EHR integration.
The ordering provider’s EHR typically contains the clinical data to meet the documentation and medical necessity requirements but, without data integration, they must often be manually transcribed onto paper and faxed to the payer or benefits manager. With EHR integration monitoring, a prior auth status is simple. When a change in status is entered by the payer, that change automatically populates into the EHR.
If the Lab, Pharmacy, or Infusion provider can ease the administrative burden through data integration, then those ordering providers will be more likely to continue to refer orders to them. Data integration becomes a competitive advantage for those alternates sites of care that incorporate it into their offerings.
Patients also benefit. Actionable clinical data is accurately shared between providers. Turnaround time on orders for scheduling, eligibility and benefits verification and prior authorization approval all improve, leading to more satisfied patients.
Physician Satisfaction + Patient Satisfaction = Expanded Referral Network
And an expanded referral network means increased revenue.
To learn more about how Myndshft is leveraging FHIR to provide seamless integration with EHRs to automate Insurance Eligibility, Benefits Verification, Patient Financial Responsibility, and the Prior Authorization process please Contact Us.