When healthcare organizations share and leverage their data between all stakeholders, they enable timely access and analysis of data at point of care. However, there are barriers in creating an efficient and effective clinical data exchange. While most of the blame is put on lack of interoperability or the cost involved in creating a universal data exchange platform, there are other issues like data blocking and lack of trust. As major stakeholders in the health ecosystem, payers are now focusing on creating their own data exchange with external provider data sources to drive their value based care delivery and reimbursement models.
Why clinical data?
Payers are positioned to get a lot of data on their members through claims and this data often lacks timeliness or clinical depth. Claims data only tells a part of the story; gaps in care often begin as gaps in information. Payers benefit by tapping into the clinical data sitting in siloes within hospital EMRs, clinical labs and other clinical data sources.
- Lack of interoperability hinders the capacity to create a cost-effective clinical data exchange.
- Over 80% of health care data is unstructured or not associated with a predefined data model.
- Information systems cannot read or use free text data.
- Provider systems struggle with compatibility, due to too many electronic transaction standards, clinical terminologies, or outdated standards.
- Systems use proprietary and internal coding methods that eventually need to be translated; for example there could be many ways to represent “myocardial infarction” commonly known as “heart attack”.
- Data blocking, where EHR vendors make it difficult or charge exorbitant fees to exchange information outside the organization.
- Providers are cautious in sharing information with payers due to uncertainty about performance standards or accountability on the part of payers.
Breaking down the barriers
Omni-HealthData has a unified integration tools set that includes ANSI X12, HIPAA, HL7 and more. It can enable payers to rapidly connect with disparate sources of data to create a trusted process to onboard data from provider partners. The reference data management process will lookup and validate clinical terminologies and code sets and allow source specific or proprietary code sets to be loaded and mapped to standard code sets.
Payers can leverage data governance tools to share data quality reports with their external data partners. This creates a continuous feedback process improving the external system’s data quality over time. For example, a mistyped SSN can trigger a member data remediation ticket for a Data Steward to review. When the information is communicated back to the EMR data source it will help to rectify that error at the source system. Creating a bi-directional data exchange where payers share information with providers improves data transparency and accessibility and improves trust.
When payers use Omni-HealthData’s outbound CCS interface, they can share longitudinal clinical history, patient financial, and risk data. Sharing of information leads to increased collaboration between provider organizations while providing clinicians with better opportunities to meet performance goals and earn financial incentives.
Additionally, providers can utilize the member journey care management InfoApp to see their data in action, giving them greater visibility into the member’s care, revealing compliance or actual gaps in care for the provider and member to close. The automated data exchange would further reduce the provider’s administrative burden by eliminating data entry into assessment or attestation forms.
HIMSS defines Health Information Exchange as “The capability to move clinical information among disparate healthcare information systems and maintain the meaning of the information being exchanged." Some organizations do not have the incentives to share data because of market-based competition while others are sceptic about the value driven from participating in a data exchange. The sharing of data benefits the patient, providers and the payers who then have more data from which to help improve medical outcomes. Omni-HealthData can help payers create a sustainable bi-directional data exchange with their provider partners by breaking barriers of distrust and quickly establishing value that would allow meaning collaboration between the two with the mutual goal of improving patient satisfaction and delivering better health outcomes.