Strategic Guidelines for Getting Started with FHIR

In today's rapidly evolving healthcare landscape, the ability to securely and efficiently exchange patient data is paramount. The Fast Healthcare Interoperability Resources (FHIR) standard has emerged as a powerful tool to address this challenge. By providing a common language for healthcare data, FHIR enables seamless interoperability between different systems and organizations. 

What is FHIR? 

FHIR is a comprehensive framework that includes a set of data structures, elements, and APIs designed to support the exchange of electronic health records (EHRs) and other healthcare information. It offers a flexible and extensible framework that can accommodate a wide range of use cases, from clinical decision support to population health management. 

Getting Started: A Guide for Providers and Payers 

The journey to adopting FHIR can seem daunting, but with the proper guidance, it can be a rewarding experience. Below are key steps that can help providers and payers get started.  

Providers 

Payers 

Key Considerations for Adopting FHIR 

As you embark on your FHIR journey, there are several vital factors to keep in mind, which include the following:  

Regulatory Compliance

Why it matters.  Adherence to regulatory standards is essential to avoiding penalties and maintaining patient trust. FHIR can help organizations comply with regulations like HIPAA and CMS mandates. 

Considerations.  Stay current with the latest regulatory requirements to ensure your FHIR implementation plan aligns with these standards. You may want to consider consulting with legal experts to understand your specific obligations. 

Data Quality

Why it matters.  High-quality data is crucial for accurate decision-making and effective care delivery. Inconsistent or inaccurate data can lead to errors, inefficiencies, and poor outcomes. However, disparate organizations can read and interpret the specifications differently, making it vital to collaborate and ensure alignment/understanding of the data values that populate the data elements. 

Considerations.  Establish data quality standards and implement processes to ensure data accuracy, completeness, and timeliness. Consider using data validation tools and techniques to identify and correct errors. A platform like the Avaneer Health Network can act as an intermediary to ensure that there is a shared understanding between participants regarding data exchange. 

API Readiness

Why it matters. Deploying a FHIR server provides the required APIs, but your organization’s infrastructure and systems must be prepared to fully leverage them. Efficient API performance and system integration are key to ensuring smooth data exchange and interoperability. 

Considerations. Evaluate your organization's network capacity and system readiness to support real-time FHIR interactions. Ensure that internal systems and external partners can successfully interact with the FHIR server's API endpoints. This includes verifying the capability of your IT environment to manage the expected volume of API requests and responses, as well as the ease of integrating with other existing healthcare systems. 

Security & Privacy

Why it matters.  Protecting patient data is a top priority. A breach of sensitive information can have serious consequences, both legally and reputationally. 

Considerations.  Implement robust security measures to protect FHIR-based systems and data. This not only involves the use of appropriate encryption, access controls, and security governance but also leveraging modern technology and architectural approaches to minimize risk.  

Customization

Why it matters.  While the FHIR standard is flexible, it may not align perfectly with your organization's specific needs. Customization can help ensure those needs are met. However, this can lead to data interoperability issues, as highlighted in the data quality section above.  

Considerations.  Identify areas where customization is necessary and carefully consider the implications of making changes to the standard. Involve subject matter experts and technical teams to ensure that customizations are implemented effectively. 

Conclusion 

FHIR-based data exchange continues to be at the forefront for addressing the challenges of healthcare interoperability. By understanding the fundamentals of FHIR and following the strategic approach outlined above, providers and payers can leverage this technology to improve patient care, enhance operational efficiency, and drive innovation in the healthcare industry. 

Learn how your organization can partner with Avaneer Health for FHIR implementation

3 ways IT leaders can improve the business transactions of healthcare

Most healthcare IT leaders have already laid out their priorities for 2024 and a recent report by Bain & Company finds that revenue cycle management, clinical workflow optimization, and patient engagement are top priorities. To address the challenges in these areas, healthcare leaders have significantly increased investments in technology and now consider IT a “strategic priority,” citing its ability to enhance revenue and reduce costs by “streamlining labor-intensive processes.” These include subset areas like “revenue integrity, charge capture, and complex claims.” 

Organizations can modernize their tech stacks to drive savings and reduce administrative burdens. We have identified three central areas of opportunity: data platforms and interoperability, automation, and AI. 

Data Platforms and Interoperability 

For all our efforts towards interoperability, data remains siloed across the healthcare ecosystem and continues to be difficult to access in the delivery of care. This is why our industry is still highly reliant on APIs and third-party aggregators to share data. While healthcare is making headway with industry-wide data exchange initiatives and the increasing adoption of industry standards like FHIR®, both initiatives require a great deal of work, money, and IT resources. 

Today, there are cloud-based data platforms that create a new kind of interoperability where payers and providers can share information without building and maintaining individual connections. These platforms enable data to be continuously refreshed and current, eliminating the need to question accuracy or integrity. These platforms include advanced technological components such as AI, machine learning (ML), and robotic process automation (RPA) meaning participants reap the rewards of greater interoperability without making substantial infrastructure investments. 

Avaneer Health’s network and its platform are designed for interoperability, applying a modern, secure infrastructure that leverages the FHIR standard for data exchange. Thus, payers and providers communicate and transact directly, eliminating the need for third-party solutions and reducing the number of transactions needed to support operational workflows. Because the platform enables permissioned and audited data sharing without data aggregation, data owners have more control over their data. 

 Automation 

We’re all familiar with the amount of financial waste in our industry, much of it related to inefficient manual administrative processes. While industry leaders have talked about the need for automation for years, today’s modern technologies hold much more promise than those of the past. Robotic process automation (RPA) is a prime example.  

RPA works by mimicking repetitive processes through rule-based tasks. “A set of scripted processes can access applications and data sources using structured data and logic to automate decisions according to predefined business rules and conditions.” In this way, RPA eliminates the potential for human error in manual processes while also increasing productivity with fewer staff.  

RPA is ideal for many patient access and midcycle processes like scheduling, coverage, and eligibility verification—all of which can impact the patient experience. RPA can also help with coding and can flag documentation requirements for prior authorizations and medical necessity as well, helping to reduce delays in care and denied claims, streamline revenue cycle processes, and optimize reimbursement.  

 Artificial Intelligence (AI) 

According to a new study by KLAS Research and the Center for Connected Medicine, 79% of health executives surveyed said that "AI was the most exciting technology in healthcare.” It seems each day we hear of new clinical and administrative use cases for AI. But when it comes down to choosing the appropriate application in our own organizations, the decision should be made by measuring both short-term and long-term gains and weighing them against available resources and capabilities. Organizations must ask themselves which applications are quick wins, and which will take more time and effort. Both need equal attention.  

 

Just 6% of IT leaders surveyed say they have a strategy in place for using generative AI, although 50% say they are or will be planning one soon. 

 

One ingenious application of generative AI that could be considered a quick win is its use in responding to patient messages in the patient chart. We’ve heard a lot recently about the unmanageable number of emails providers receive each day from patients. While some health systems have begun charging patients to send messages to their providers via MyChart, others are testing AI as a way to answer more common questions. One approach gives patients a tool and then punishes them for using it, while the other seeks to solve the problem with innovation. This is an excellent example of how AI can be used to facilitate better care while also improving the patient experience and reducing stress on providers.  

Longer-term applications of AI include better risk prediction for disease stratification, faster clinical trials, improved disease diagnoses, and better outcomes. But these more complex applications will only be beneficial if organizations can deploy them in a cost-efficient, timely, and easy-to-scale manner.  

Healthcare systems have invested heavily in legacy systems that don’t typically play well with modern technologies. Bolt-on solutions and multiple APIs are required just to share information with other providers and payers. And managing these systems consumes most of a health systems’ IT budget, leaving little room or resources to integrate AI applications and models cost-effectively. 

Avaneer Health can Unlock the Full Potential of IT Investments 

Interoperable data platforms, automation, and AI have the potential to genuinely transform our industry by enhancing patient experiences, improving outcomes, and significantly reducing clinical and administrative inefficiencies. But fully realizing these benefits requires a new kind of network through which these innovative technologies can be leveraged. That network is here today. 

 The Avaneer Health Network is a secure, permissioned, and decentralized network. Once a participating payer or provider connects to the network, they never have to establish a direct connection to any other participant. Data remains decentralized, and participants can control how and with whom they collaborate. Through an authorization process, their data can be shared with anyone on the network whom they have approved to receive it. Once the connection is established, data can flow freely and in real time, eliminating interoperability barriers and allowing genuine data fluidity. 

Healthcare leaders have realized not just the need, but the immense potential of investing in technology. To get the most from those investments, they’ll need to be able to integrate and deploy those technologies in a way that makes them usable across the entire ecosystem. Once all the pieces are in place, we will truly be able to simplify the business of healthcare. 

Learn how Avaneer Health can help your organization achieve optimal results from your IT investments. 

FHIR® is the registered trademark of Health Level Seven International and is used with the permission of HL7. The use of this trademark does not constitute a product endorsement by HL7. 

Healthcare happens in real time. Shouldn't your data?

Insider News for Nov/Dec 2023

Our team has fun calling out the obvious challenges of creating and launching healthcare infrastructure. Among our many sarcastic hashtags, we use #killthefax. It reminds us that it wasn’t that long ago that medical records were paper, data comes in multiple formats and is often in disparate databases, and our industry is still in the midst of digital transformation. It's a paradox that most healthcare technology professionals will understand.

Further, AI is on everyone’s mind as a transformative technology across many industries. At the same time, data sharing in healthcare is still done via fax. This century-old technology still has us firmly in its grip, even as AI-enabled healthcare solutions are hitting the market!

No more excuses

The fact is that we can communicate without the fax machine. We can share data and transact with others in real time. And we can apply AI to large data sources to glean critical insight. Through the increasing adoption of industry standards like FHIR, we’re able to normalize data and continue to make progress and evolve. The challenge is that developing and deploying FHIR-based solutions is expensive and requires extensive IT resources to manage.

There’s a better way

The Avaneer Health platform and network are designed for interoperability and simplicity. With a modern, secure infrastructure and a built-in suite of FHIR-enabled tools, payers and providers can communicate and transact directly without requiring huge infrastructure investments. And because the network enables permissioned and audited data sharing without data aggregation by Avaneer Health, it eliminates the need for third-party solutions, giving data owners more control over their data.

There’s no excuse to stay tethered to the fax, file exchanges, or data aggregation. Payers and providers can begin reaping the rewards of greater interoperability today.

In This Issue

Industry Highlights

Identifying the right use cases for federated learning and analytics

Integrate.ai

Most data science initiatives fail because they don’t have access to the appropriate data. But that’s changing thanks to federated learning for data silos. “In traditional machine learning, all data must be centralized in one database before training a model. In federated learning, models are trained on decentralized datasets - that is, the data resides in two or more separate databases and never needs to be moved.”

This insightful article shares the five steps to identifying use cases for federated learning.

Read More

Featured Avaneer Content

What if you could access all active and inactive coverage data in real time without aggregating data? And what if that information were always updated and available within your own system? It’d lead to:

Request a personalized demo

Collaboration Services for Developers: tools and services for launching solutions

Watch a short demonstration of how Avaneer Collaboration Servicesᵀᴹ enables developers to launch solutions seamlessly and automate workflows.

Watch now

From the Avaneer Podcast

New podcast focusing on innovation

The Avaneer Health team is launching a new podcast that will feature discussion with innovators who are disrupting how healthcare works, truly transforming processes and infrastructure, and challenging the status quo. Our first episode describes our vision for the podcast.

Listen here

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What if getting accurate patient coverage could be easier?

The vast adoption of high-deductible health plans means consumers are financially responsible for a greater portion of their medical costs. Yet, our current revenue cycle was designed around commercial and payer reimbursement, not patient payments. Today, collecting patient payments has become a challenge for many provider organizations and creates significant financial stress for both the patient and the provider. The first step in collecting is identifying a patient’s coverage and determining the final amount they will owe.  

Why is coverage discovery so challenging? 

The underlying problem spans data silos, lack of interoperability, and data latency between provider and payer systems. These challenges create extensive lags in getting updated information on multiple coverages or changes in coverage status. Consider that consumers change their health plans numerous times throughout their lives. Since most benefits must be renewed each year, even if consumers don’t change carriers, they can still change their benefits plans.  

Often, patients are unsure of their current coverage or whether they have secondary or tertiary coverage. This means providers must manually call insurers or comb their websites to find updated coverage information, sometimes using bots and AI solutions. Even when they find the coverage information, there is no guarantee the information is accurate.  

Failure to capture complete, accurate patient coverage prior to service can lead to delays in care and denied claims. In fact, the lack of precise coverage information is the second leading cause of denied claims, leading to increased write-offs, delayed reimbursement, and lost revenue.  

In addition to the impact on the provider’s bottom line, the impact on patients is also significant. Patients may end up paying for a service that was covered or receive care they thought was covered only to find out later it was not. When the claim is eventually denied, the patient can end up with an unexpected medical bill at no fault of their own. This can cause distrust and lead to a dissatisfactory patient experience. It may also damage the provider organization’s brand reputation.  

What if… 

What if there were a way for providers and payers to connect to a single network and get real-time access to always-refreshed, accurate, and complete primary, secondary, and tertiary patient coverage information—without the need for a third party? Providers could spend less time chasing information, leaving more time for patient engagement. IT teams would have fewer connections to manage, reducing costs and improving operational efficiencies.  

What if denied claims due to timely filing issues or inaccurate coverage or eligibility information were eliminated? Providers would experience fewer write-offs and payer takebacks, a reduction in A/R days, better cash flow, faster and more accurate reimbursement, improved self-pay collections, and reduced denial-related costs. 

“What if” is now a reality 

We no longer have to ask “what if” because the solution is here today. Avaneer Coverage DirectTM, available on the Avaneer Network, enables payers and providers to share information over a single network without building and maintaining separate connections to a myriad of different services, trading partners, and counterparties within the industry. The Avaneer Network becomes a shared source of knowledge. 

In the network, payers and providers submit data to their SparkZoneTM, a cloud-based environment, where it becomes discoverable based on permissions set by each participating organization. Users connect to the network via the cloud, where the ID keychain and master index locate the information requested, match it to the data available, and then deliver it to requestors who are permissioned to access it. Data remains in its existing location and under complete control of the data originator.  

The Avaneer Network is a secure, permissioned network and platform built on data fabric architecture. Certification, cybersecurity, and compliance are all built into the design. Because data is permissioned at the gate instead of the gateway, it is more secure and less vulnerable to a breach.  

Success story 

A non-profit academic medical center and a national payer are early adopters of Avaneer Coverage DirectTM and have collaborated on Avaneer Coverage Direct design and outcomes. Early results show that access to more complete coverage information gives insight into data management processes and operational workflows, in addition to the following benefits. 

Learn how Avaneer Health can help your organization reduce denials and write-offs, improve collections and reimbursement, enhance the patient experience, and lower administrative costs.

Closing gaps in interoperability could improve healthcare outcomes

The need for greater interoperability is escalating due to an increasingly sicker population. According to the CDC, 60% of Americans have a chronic disease, while 40% have two or more. As our nation ages, these numbers will likely increase as older individuals typically have more chronic conditions that require more—and more complex—care. Chronic disease is the leading driver of our $4.1 trillion annual healthcare spend. Effectively managing patient care, especially for those with chronic conditions, requires continuity across the care continuum and that continuity isn’t possible without closing gaps in interoperability first.

The disconnect

According to HealthIT.gov, 32% of individuals surveyed who had seen a provider in the previous 12 months experienced a gap in care due to ineffective information exchange. Nearly 20% had to bring a test result with them to a provider appointment; 14% had to wait an unreasonable period to get their results; 5% had to have a test or service redone because the data from the first test or service wasn’t available; and 5% had to provide their medical history more than once because the provider couldn’t find their existing chart. This lack of access to timely, accurate information is one of the primary reasons for gaps in care, a negative care experience, higher costs, and poorer outcomes.

Post-acute care

Consider the impact of interoperability gaps on patients recently discharged from a hospital to a post-acute care facility. The Agency for Healthcare Research and Quality (AHRQ) reports that 20% of patients discharged from a hospital experience an adverse event after just three weeks. The report finds that 40% of patients are discharged with test results still pending. The same percentage is discharged with orders for a “diagnostic workup,” but often without a way to close the loop on whether that workup occurred. This may be why 99% of providers choose a post-acute provider that offers interoperability over one that does not. This is likely driven by value-based care models that penalize readmissions and poor outcomes.

Coverage accuracy and insight

Another example of how gaps in interoperability cause gaps in care involves the accuracy of coverage information. Now that patients are responsible for a larger portion of their healthcare costs, they need price transparency. While many providers offer patient responsibility estimations, those estimations are often incorrect. One study found that 79% of providers are unable to correctly estimate a patient’s out-of-pocket costs due to inaccurate price and coverage information. When patients don’t know the ultimate cost of a service, they may be more likely to put it off or skip it altogether. For providers participating in value-based care and population health initiatives, this lack of benefits and coverage information can impact outcomes and, thus, reimbursement. It can also increase denied claims and create issues in the revenue cycle, leading to cash-flow challenges and delayed or inaccurate reimbursement.

Poor financial transparency can also impact the patient experience and patient satisfaction scores. One study found that 60% of patients would consider changing providers due to incorrect estimates or unexpected bills. When a patient overpays, it can take months to get a refund. And when patients pay less than they owe, they can be hit with a surprise bill they weren’t prepared to pay.

A different way of sharing data to reduce gaps in interoperability and gaps in care

While we’re making headway with initiatives like the Trusted Exchange Framework and Common Agreement (TEFCA) and the increasing adoption of industry standards like FHIR®, they require a great deal of work, money, and IT resources for healthcare organizations. However, a recent innovation is advancing interoperability in ways previously thought impossible. It begins with a digital ecosystem and decentralized network built on a platform and data fabric architecture.

Once payers and providers connect to the network, they can connect with any other payer or provider on the network to share information, and they can do it without building and maintaining multiple connections. Instead of having to aggregate data, it is always available and accessible in real time. Information is continuously refreshed and current, eliminating the need to question accuracy. And because the network is cloud-based and includes advanced technological components such as AI, participants benefit from greater interoperability without making huge infrastructure investments.

The network applies modern, secure infrastructure designed specifically to meet the needs of today’s healthcare businesses. Leveraging FHIR standards for data sharing, the network facilitates peer-to-peer communication directly between payers and providers without the need for third parties, thereby reducing the number of transactions needed to support operational workflows. And because the network enables permissioned and auditable data sharing without data aggregation, it gives data owners more control over their data.

A network and platform that simplifies the business of healthcare

As we start to close the gaps in interoperability, it’s the perfect time to reevaluate some of our long-standing beliefs about what’s possible within the revenue cycle. We don’t have to depend on data aggregation, numerous APIs for point-to-point connections, and third parties to conduct the business of healthcare. There’s a new way and it’s already used by some of the nation’s largest payers and providers.

Discover more about Avaneer Health, Avaneer Coverage Direct, and how it can help your organization close interoperability gaps to reduce gaps in care. Let’s simplify how healthcare operates together.

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