How healthcare can become more interoperable with a decentralized network

The back-office administration  of healthcare is fragmented and full of manual, inefficient processes that impact patient care, provider reimbursement, and costs. These processes are a result of our inability to connect effectively. While payers and providers have invested millions in multiple platforms and legacy systems, many still lack full integration and interoperable functionality.

The annual cost of administrative inefficiencies in the U.S. healthcare system has reached into the billions, with billing, coding, physician administrative activities, and insurance administration being primary drivers.

An ecosystem full of obstacles

The challenges of today’s outdated interoperability architecture are significant. From a connectivity standpoint, partner connectivity and workflows require multiple vendors and system integrations. From a data management standpoint, today’s interoperability systems require numerous third parties to support, which has led to a lack of traceability, control, and auditability, as well as security issues. These third parties must aggregate, store, and repurpose data, which means they control the redistribution to payers, providers, and partners. Because of this, payers and providers have little control over when, where, and how they can access it.

Most healthcare organizations have invested in digital and interoperability strategies that, ultimately, have narrow potential and limited scalability. The high costs to maintain connections to multiple third parties require payers and providers to implement and maintain numerous single-use, point-to-point connections.

We now have a web of interconnected systems that don’t easily adapt to evolving trading partner business needs. This has resulted in a wide array of custom, proprietary integration requirements for APIs and third-party platforms—all of which further deteriorate our industry’s quest for interoperability and administrative efficiencies.

Manual transactions, administrative burdens, poor interoperability, and costly and ineffective legacy systems have led to increased total processing spend, provider burnout, poorer outcomes, and limited innovation.

A new kind of interoperability in healthcare

Instead of continuing to add fixes on top of a broken system, healthcare needs to create a new, better system—a system built with a new kind of interoperability.

The term interoperability has different meanings. While we can all agree that sharing data is at the heart of the definition, there are disparities in what that looks like. For example, Fast Healthcare Interoperability Resource (FHIR) has given us a common set of protocols and standards for a payload of transactions on a network. Still, alone, FHIR does not give us full interoperability.

In a truly interoperable healthcare system, data would not need to be requested, aggregated, and validated each time it is needed. Instead, it would be continuously refreshed, always current, and accessible in real time via a secure, decentralized network to those who are permissioned to access it.

What is a decentralized network?

The typical network design consists of a primary server that manages all the information and activities on the network. On a decentralized network, there can be multiple servers acting as primary servers. They each manage information on their own while still connecting with each other. In this way, they “balance the load and distribute the work across the system.” This helps improve network resiliency and data redundancy; if one node goes down, the others are unaffected. Likewise, because data exists in multiple locations throughout a decentralized network, it cannot be changed in one place without changing it across the network.

decentralized network

Benefits a decentralized network can deliver include:

Eliminating data silos and resolving payer-provider friction

Payers and providers have made progress in improving data accessibility throughout their own enterprises but remain challenged to seamlessly make data accessible between organizations. That lack of data fluidity has led to an industry with a complete lack of transparency that has led to friction, distrust, and data hoarding.

With a decentralized network, payers and providers achieve complete transparency and data fluidity, and they do it without involving third parties. This allows for enriched transactions, providing more actionable patient and procedure-level specificity and clarity. Without a third party, payers and providers require fewer transactions to support operational workflows, while improved data insight supports more effective data management strategies.

This new way of transacting healthcare is not just redesigning current processes. It’s not just about streamlining the way we currently do things. It’s about disrupting how we conduct healthcare and doing things differently. It is about simplifying the business of healthcare.

A new era of interoperability

While we’ve made progress on the road toward interoperability, we have to ask ourselves if our current trajectory can get us where we need to be. Avaneer Health sees a new way forward. We are building a digital ecosystem that accelerates change and enables us to reinvent how healthcare operates. Our decentralized network is now live, and we invite you to join us as we reimagine healthcare together.

How to Break Down Data Silos

Positive momentum is happening in healthcare interoperability. The topic seems to garner headlines every day, with a few in our newsletter this month. It’s almost as if interoperability has recently ignited after years of moving at a snail’s pace.

I’m challenging healthcare to think differently about how we work together. More is to be gained by working together than by keeping data siloed. Achieving this type of interconnectivity requires a nationwide healthcare network that allows all participants to share information, collaborate, and launch solutions for all of healthcare. This type of digital fabric can combine disparate data for a more complete patient profile and the related administrative data needed for the business of healthcare. This level of interconnectivity can tear down the barriers in healthcare for business and people.

While there seems to be so much chaos in the world right now, it’s important that we don’t overlook the really great things happening in healthcare. It’s time to celebrate the possibilities, then roll up our sleeves and work together to make them a reality.

Stuart Hanson
CEO, Avaneer Health

In This Issue

​​​​​​Featured Content

Forget Micro-Networks: How Avaneer Health is Building the One Health Data Exchange

Imagine our country without interstate highways, where each city has to build its own roads to every other city. The costs and resources needed to create such a micro-network infrastructure would be monumental. Yet, this is the scenario playing out in healthcare as payers, providers and suppliers build one-to-one pipelines with each other to exchange data. There has to be a better way. Imagine our country without interstate highways, where each city has to build its own roads to every other city. The costs and resources needed to create such a micro-network infrastructure would be monumental. Yet, this is the scenario playing out in healthcare as payers, providers and suppliers build one-to-one pipelines with each other to exchange data. There has to be a better way.
Watch The Video

It’s Time to Start Innovating to Make Administrative Data Interoperable

Just as clinical interoperability creates efficiency and a better healthcare experience, greater administrative interoperability could help eliminate many of the costs related to billing and insurance. The healthcare industry needs to expand its view of interoperability to include administrative data and embrace innovation in this area.
Read More

Unblocking Interoperability with a Blockchain-Powered Network

Many of the challenges in our U.S. healthcare system could be solved through data fluidity and interoperability. We could reduce administrative costs, improve access to timely care, enhance the patient experience, and save billions of dollars each year. While efforts have been ongoing toward this end, today’s more advanced technology provides an opportunity to achieve true, industry-wide interoperability much faster.
Read More

Industry News

ONC Releases United States Core Data For Interoperability Version 3
EHR Intelligence

After receiving more than 800 public comments, the ONC has released the United States Core Data for Interoperability Version 3 (USCDI v3), which adds 24 data elements among these classes: health insurance information, health status/assessments, laboratory, medications, patient demographics/information, and procedures. The addition allows the capturing and sharing of healthcare insurance coverage in a standardized way.
Read More

Interoperability Among Office-Based Physicians in 2019
HealthIT.gov

In 2019, 65% of physicians surveyed said they exchange patient health information electronically with providers outside their organization, while 35% said they still rely primarily on fax (paper or electronic) and mail for information exchange. An even more common barrier, 85% reported challenges electronically exchanging information with providers using a different EHR.
Read more eye-opening findings from the ONC’s report on interoperability progress among physician offices.

From the Avaneer Blog

Unlocking the Full Potential of Healthcare

In an industry where new solutions often bring with them even greater complexities, the tide is—finally—turning. What started as a conversation between a tech giant and one of our nation’s largest banks has become a healthcare consortium of industry powerhouses. The goal? To create a network where all healthcare stakeholders can seamlessly collaborate, share data, and build innovative solutions to create the healthcare ecosystem of tomorrow.
Read More

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