By Lesley Brown, SVP of Project Management at Halfpenny Technologies
The potential benefits to health plans of compiling a complete picture of their member’s health status are plentiful.
It really goes without saying that the more data and information you have about your members, the better help and guidance you can give them. You can ensure they receive the most appropriate and best care without unnecessary replication of services. And importantly… without redundant costs! For a long time, health plans have been reasonably content with the data that they obtain from medical claims. But as payers become more engaged in actual care management and strive for value based care for their members, many are realizing that the data from claims offers only a part of this comprehensive picture. Some of the pertinent detail, such as a lab test value, is often absent from a claim. Some care may not always result in an insurance claim.
The utilization of clinical data, such as that obtained from a continuity of care document (CCD) from a physician’s practice, can help enrich this health record for your members. And the brilliant thing is – you do not need to wait for that first visit to the doctor with you as their medical insurer to occur. If the member has remained with their doctor but changed insurance plans, their historical information will still be in their clinical medical record.
Unfortunately, gathering all this clinical data from multiple sources in order to take advantage of it is not as easy as it may sound. There are many health information systems, such as EMR’s and LIS’s, that are in use by physician groups and hospitals. These medical record systems are built in a proprietary way in order to ensure a market share or niche for the vendor. As a result, they use different templates and store common data elements in different formats. This is all thanks in part to variations in the interruption of industry standards. Due to this variation these electronic record systems struggle to communicate with each other, never mind a vested third party that might be looking to take advantage of this goldmine of clinical data. You’ve heard the term – there is a lack of “interoperability” in healthcare. As a result, health plans that are interested in gathering this clinical data so they can compile a more complete picture of their member’s health are faced with a project that is time consuming, extremely expensive, and often results in failure.
Looking for some assistance in collecting clinical data? Halfpenny Technologies (HTI) has been in the clinical data exchange business for more than 15 years. Over that time, HTI has 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.