By John Reeves
Whether checking in a new patient, delivering vital clinical information at the point of care, or teaming with third-party services, healthcare providers and payers must integrate a diverse set of systems to operate effectively.
To achieve the improvement needed for value-based care, healthcare providers and payers face several data hurdles, including regulatory compliance and industry standards, outdated healthcare IT systems, and managing the complexities of mergers and acquisitions.
Ensuring Compliance With Regulatory and Industry Standards
Healthcare organizations must navigate a complex regulatory landscape that changes frequently. This makes it difficult to aggregate data into a “single version of the truth,” and the difficulty reaches far beyond the deployment of an electronic medical record (EMR).
Healthcare interoperability requirements for providers and payers must also meet high security standards. Organizations must keep in mind that:
- U.S. law now mandates for Medicare and Medicaid that healthcare organizations must meet the Meaningful Use Stage 1 criteria to use EMR records in a “meaningful” way. That means more applications must be able to process these records.
- HIPAA-covered entities need to use ICD-10 codes to receive payment for healthcare services given, or they risk providing care and not being paid. The complexity of ICD-10 codes exceeds those of ICD-9. So current data mapping is obsolete. New application integration and mapping scenarios are needed.
- Healthcare organizations must comply with Health Level-7 (HL7), the standard for information exchange between medical applications (as well as payers and processors).
- In the UK healthcare organizations increasingly expect applications and platforms to follow NHS standards. This kind of regional or national compliance scenario is likely to happen elsewhere.
Modernizing Healthcare IT to Achieve Interoperability
For all organizations — and healthcare is no exception — modernizing IT is the gift that keeps on giving. In fact, modernizing IT may be the key to cost-effective delivery of value-based care.
The demands of data protection laws, technology standards, and healthcare metrics drive the value-based care model. Evaluating those metrics while adhering to technology and compliance standards involves securely accessing far more data than in the fee-for-service model. It highlights the need for improved interconnection among systems such as EMRs, health information exchanges (HIEs), and patient administration systems (PASs).
Healthcare providers must manage medical practices and business operations to generate safe, measurable and economically viable outcomes for patients while driving efficiency. This involves managing systems in:
- Finance and accounting
- Clinical practice
- Patient outreach
- Third-party services
Any move to modernize IT systems will start by digitizing medical records. But that’s low-hanging fruit. The real work lies with integrating legacy applications and clinical systems from a variety of vendors and connecting data from several branches of hospitals or healthcare networks.
According to one healthcare CEO, the most progressive organizations have been the quickest to modernize their digital infrastructure. Middle of the pack companies are working to take modest steps to modernize.
Shockingly, the CEO estimates that 60% of healthcare organizations have said that they are not modernizing regardless of the cost or impact. This 60% will either be acquired or go out of business.
Healthcare Organizations Face Challenges of Mergers and Acquisitions
In healthcare the business drivers and potential roadblocks that influence the success of a merger include:
- Rapidly integrating organizational resources
- Minimizing business disruptions
- Driving quality improvements
- Improving healthcare services
M&A activity can complicate the task organizations face as they strive to embrace the accountable care payment and revenue models that support value-based care. They must cope with:
- Redundant systems
- Enormous data transformation and migration issues
- Hard to maintain proprietary interfaces
- End-of-life legacy products with dwindling support
- Evolving industry standards that stress existing technology systems
Moreover, healthcare organizations often cannot retire legacy systems because of data they hold. Yet they’re expensive to operate and difficult to modify in response to new requirements. Their rigid architectures cannot accommodate cloud integration and mobile applications without extensive custom coding.
Interoperability Starts with Accurate, Validated Data
No matter who you share data with internally or externally, Boomi Master Data Hub ensures your data is consistent across your extended organization. With Master Data Hub you can:
- Empower data stewards to easily model, match, synchronize, cleanse and enrich data across domains
- Create business rules to alert your team and help resolve duplicates, fix data entry issues and correct erroneous data
- Address the three components of unified data management: application integration, data governance and domain-specific data quality
Boomi can help organizations correct data deficiencies, including data quality and metadata issues for structured and unstructured healthcare data. With Boomi, healthcare providers and payers can create a single view of the patient across healthcare systems, including siloed EHRs.
Once they ensure the quality of their data, healthcare payers and providers can drive continual, tangible care improvements, which creates true patient-centric care and better population health.
Data Creates Value in the Business of Healthcare
The entire healthcare ecosystem benefits from the improved quality and access delivered by the Boomi platform.
Create one-to-one patient journeys. Providers can meet rising patient expectations for a personalized healthcare experience by connecting internal and partner systems. They can improve communications and medical outcomes with accurate, up-to-date patient data.
Build patient engagement. Payers and providers can simplify the member experience with disparate data integrated and accessible through self-service portals and mobile apps. They can improve transparency with a complete record of patient interactions and related billing and payments while identifying opportunities for building wellness programs.
Focus on patients, not integration. Whatever a company’s role in healthcare, Boomi simplifies and speeds needed integrations. Pre-built connectors, support for HL7 and other data standards, and low-code development let stakeholders focus resources on the healthcare mission, not costly and time-consuming integration.
Build collaborative networks. Securely connect with healthcare partners and third parties to build collaborative, patient-centric networks. Consolidate clinical, engagement and financial data while strengthening compliance with HIPAA in the United States and similar healthcare data regulations around the world.
To learn more about the Boomi platform and how it can help healthcare organizations make the transition to value-based care, please contact our experts today.
About the Author John Reeves is Boomi’s healthcare solutions evangelist.