INSIGHTS

HEALTHCARE INTEROPERABILITY

The vital role of data sharing in the administration of healthcare

What is interoperability in healthcare?

The importance of interoperability in healthcare

What causes a lack of interoperability?

What is being done to improve interoperability?

Solutions to our interoperability challenges

What is interoperability in healthcare?

According to the ONC (Office of the National Coordinator for Health Information Technology), interoperability in healthcare is “the ability of two or more systems to exchange health information and use the information once it is received.” In simpler terms, interoperability is about how healthcare stakeholders—payers, providers, and innovators—share data. There are four levels of interoperability in healthcare: Foundational, structural, semantic, and organizational.

Foundational (Level 1): Establishes the inter-connectivity requirements needed for one system or application to securely communicate data to and receive data from another
Structural (Level 2): Defines the format, syntax and organization of data exchange including at the data field level for interpretation
Semantic (Level 3): Provides for common underlying models and codification of the data including the use of data elements with standardized definitions from publicly available value sets and coding vocabularies, providing shared understanding and meaning to the user
Organizational (Level 4): Includes governance, policy, social, legal and organizational considerations to facilitate the secure, seamless and timely communication and use of data both within and between organizations, entities and individuals. These components enable shared consent, trust and integrated end-user processes and workflows

Why is interoperability important in healthcare?

The administration of healthcare includes numerous processes that are highly manual, complex, and difficult to manage, especially those related billing and insurance. This includes back-office workflows such as:

Patient coverage verification
Payer authorizations
Claims management
Payer reimbursement
Patient payments

“By transitioning to fully electronic transactions, the industry can save nearly $25 billion, or 41 percent of the current annual spend, $60 billion. The industry has already avoided spending $187 billion annually by automating transactions.”

Source: 2022 CAQH Index

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What is the impact of a lack of interoperability in healthcare?

Our industry lacks the ability—or interoperability—through which payers and providers can easily share administrative data. Prior authorization is a perfect example. Providers often send prior authorization requests via fax or email to the payer. Receiving approval can take days, weeks or even months, and can require multiple calls and emails to the payer. The result of inefficiencies such as these can cause:

		Providers
Delayed reimbursement
Denied claims
Unnecessary write-offs
Poor cashflow
Additional work

	

		Patients
Delays in care
Surprise bills
Poor patient experience
Reduced outcomes

	

Providers expect 15% of every dollar billed to be challenged and scrutinized and to expend labor-intensive and costly procedures to ultimately get paid.

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What causes the lack of interoperability in healthcare?

There are multiple reasons for the poor state of interoperability in healthcare, including:

A lack of standardized technology and data formats across payers and providers
Reliance on customized, one-to-one connections for each trading partner
Data exchange processes that make data immutability challenging
Difficulty in managing who controls/owns the data, which leads to “data hoarding”
The use of numerous, different legacy systems that create silos of data, even across single enterprises
The lack of affordable integration solutions

In addition to these challenges, data still must be aggregated and validated each time it’s exchanged. This is typically done through third-party clearinghouses, adding another cog in the interoperability wheel and further reducing data transparency in healthcare.

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LISTEN TO THE PODCAST

Forget Micro-Networks: How Avaneer Health is Building The One Health Data Exchange to Rule Them All

What we need is a one-to-many network without boundaries, where providers can access patient data with permission in real time through a single query. Instead of waiting for weeks to gain access to a patient’s medical history, providers could perform a simple query at a moment’s notice—during a patient visit, in an emergency department, or when seeing a patient who’s from across the country—giving them instant access to the information they need to make more timely, informed decisions about the patient’s care.

THAT is how healthcare becomes patient centric.

Stuart Hanson

CEO, Avaneer Health

What is being done to improve interoperability?

There are many initiatives underway in healthcare to improve interoperability. One of the best-known is the Fast Healthcare Interoperability Resource, or FHIR. Introduced in 2012, FHIR provides a standard set of rules and specifications for exchanging electronic clinical and administrative data between healthcare entities.

While FHIR and other initiatives are making headway, they still do not solve the industry’s interoperability challenges. Providers and payers still have to manage a complex web of data connections and disparate systems.

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Are there any solutions currently available to improve healthcare interoperability healthcare?

Yes! Companies like Avaneer Health are taking an innovative approach to solve interoperability in healthcare. Instead of just streamlining existing processes or adding bolt-on technologies on top of legacy systems, Avaneer Health is reinventing administrative processes altogether.

The Avaneer Health Network™ is a secure, permissioned, decentralized network and platform built on a data fabric infrastructure. Once a participant—payer, provider, or innovator—connects to the network, they never have to build a direct connection to any other participant.

Data remains decentralized.
Participants can control how and with whom they collaborate.
Through a permissioned process, data can be shared with anyone on the network who has been approved to access it.
Once a connection is established, data can flow freely between participants in real time

Avaneer Health eliminates interoperability barriers and enables true data fluidity.

DOWNLOAD THE WHITE PAPER: One Network. Many Possibilities.

How do the Avaneer Health solutions work?

Each participant on the Avaneer Health Network receives an Avaneer SparkZone™, their dedicated, private, secure, cloud-hosted environment, and their “home base” on the network. Their SparkZone includes a pre-packaged suite of utilities and services, providing everything they need to connect, collaborate, and transact with other participants. Here, participants can develop and deploy their network solutions and subscribe and connect to other solutions.

The Avaneer Network also includes Avaneer Collaboration Services™, a person-centric identity service connecting to data discovery workflows that unlock access to permissioned data. The authorization review and exchange of data are trackable, auditable, and immutable within each participant’s SparkZone. Because this happens in real time, participants have immediate access to the data they need when they need it.

The Avaneer Solution Exchange™ is another feature of the Avaneer Health Network. This is where participants can discover, offer, and source other solutions on the network. It’s a shared resource for the entire Avaneer Health Network community.

Let's reinvent healthcare together.

Avaneer Health sees a new way forward. We are building a digital ecosystem-a network that accelerates change and enables us to reimagine how healthcare is administered.

Find out how we are leading the change to reinvent how healthcare operates.