How interoperability benefits healthcare administrators

The advantages of interoperability go beyond clinical decision support to inform patient care

By | 3 minute read | June 14, 2021

Two young women wearing masks work on laptops in an office environment

Interoperability of healthcare data is imperative — not just for improving clinical outcomes but for simplifying healthcare administration as well. A recent study found that nearly 34% of national health costs in the US goes toward administration. One primary driver in healthcare administration workloads is the need for constant manual movement of healthcare data, which often requires people to rely on “old school” methods to overcome health data incompatibilities, such as faxing.

The inefficiency and insecurity of these methods are why leaders in the US created new regulations that require healthcare organizations to make their data more accessible and transferable. A key part of the new interoperability requirements is a set of data standards called Fast Healthcare Interoperability Resources (FHIR) that makes it easier to move healthcare data from one system to another. The primary strength of FHIR isn’t just technical, but the fact that it’s an international standard. All parties involved have agreed on the data formatting and how to transport it via a common API.

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Healthcare interoperability doesn’t just apply to patient data like vital signs or symptoms. It also includes administrative data like appointments, ADT (admission, discharge and transfer), insurance claims and billing information. FHIR not only makes it simpler for physicians to collaborate with each other, but also makes it easier for payers, governments and other key healthcare organizations to efficiently and securely share information across organizations.

A lot of administrative work in the healthcare industry arises from the back and forth that occurs during standard claims or billing processes. Most insurance claims require patient data from electronic health records (EHRs) to back up the claim. Currently, this data is transmitted either via print-outs or via PDF files or other digital documents. This data isn’t designed for machine consumption, so payers need an actual person to review it. Because of HIPAA regulations, data format incompatibility and security requirements, these requests can result in multiple phone calls, faxes or even sending records through the mail.

While FHIR likely won’t completely eliminate the need for back and forth, it can help make health information gathering easier by providing a quicker, more secure way for healthcare organizations to get the information they need and potentially make the data friendly for other formats, which would support more automation. For example, if a payer needed to know more about a patient’s health history for prior authorization, they could simply send a standardized electronic request to the healthcare provider’s EHR through a secure API. With data stored in the standard FHIR format, the payer can customize their request to get the relevant details they need to make a decision. Plus, the standardization helps make sure there are no misunderstandings about the meaning of the data. Payers can also make additional requests, if needed, without having to call someone from the provider’s office. Requests could even be automated and sent out as soon as the prior authorization request comes in.

Take a closer look at how to achieve interoperability goals with IBM Health Data Connect

What are the advantages of using cloud to enable interoperability?

Although FHIR data can be stored in a traditional database on a standard server, organizations that want to quickly get the most value from the FHIR standard should consider using technology optimized for FHIR and for the cloud. Some of the benefits of this approach are:

Built-in support for FHIR APIs: Choosing a database or server designed for FHIR reduces the amount of maintenance or customization needed for APIs because the methods of accessing the data are part of the FHIR standard (as opposed to proprietary traditional database systems).

Real-time data ingestion: By using FHIR technology optimized for the cloud, data can be consistently collected from multiple sources, converted into the FHIR standard and sent out to other applications through APIs.

FHIR is vendor-neutral, so there are many options to choose from. Some organizations have the resources to support a custom, open source FHIR system, while others will want an experienced partner that can support them and take care of most of the technology maintenance. No matter which approaches an organization chooses, FHIR will ultimately provide better interoperability that will help improve experiences not just for physicians and patients, but for the administrators who serve them.

Learn how healthcare organizations can an achieve meaningful interoperability.