What is the state of Clinical Data Exchange for Health Plans?

By: Lesley Brown, SVP Project Management at Halfpenny Technologies

As health care in the U.S. evolves, health plans and other risk bearing entities such as ACOs, have shown an ever increasing desire to acquire clinical data for their members.   This need is fast becoming more than a necessity, as value based care begins to drive reimbursements, revenue adjustment factors and quality performance, to name just a few.   While many health plans already have access to select quantities of clinical data (think Lab results, maybe even ADT data) their appetite is now evolving towards obtaining member Continuity of Care (CCD) data.  CCD is now heralded as the “superset” of clinical data, all the medical history, test results, medications for a member in one document.

Too bad then that the coordination and exchange of this clinical data from physician practice EHRs has become a significant pain point for many health plans and clinical data integration into payer systems has made minimal advancement in the past few years.  The challenges that health plans need to overcome range from technical ones, a lack of real clinical interoperability despite Meaningful Use (MU) Stage 2 and HL7 C-CDA requirements & specifications, to business ones, often a lack of clear business value and use case evaluation can stymie the best of endeavors.

Where and how to start?  Some of the common approaches payers can take for clinical data integration include building out point to point integrations (but who has time or resources for that!), accessing a state or local HIE (this is often limited by HIEs demands for standard data structures as well as a lack of data normalization) or partnering with one of a wide variety of vendors who claim they can facilitate non-claims based clinical data integration (many of whom fall short when attempts to validate data exchange are attempted).  Regardless of the integration arrangement health plans should be advised to start small and stay focused, successful data exchange projects have a value proposition and can demonstrate cost savings or increased revenue.  Examples include, risk adjustment factors that could benefit from the diagnosis list contained in a physician practice medical record or replacement of expensive chart reviews with defined data elements from an EHR.

Halfpenny Technologies (HTI) has been in the clinical data exchange business for more than 15 years and over that time have built reusable interfaces that connect to 90%+ of the top EHR vendors and LIS/HIS systems.  HTI’s vendor agnostic approach allows the receipt of any EHR or LIS data format and in return health plans can receive clinical data in the layout of their choice. Halfpenny Technologies’ continued investment in innovative solutions has uniquely positioned the company as a national provider of clinical data exchange solutions to the health care industry.

Follow us on social media for more updates
Twitter
LinkedIn
Facebook

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s