Exploring Eligibility Verification Using LinuxForHealth and LinuxOne/Z Systems Integration

4 min read

LinuxForHealth is an open source, distributed processing network operating system, seamlessly connecting on-prem, cloud and edge devices directly to healthcare transaction systems.

LinuxForHealth can be deployed on IBM Hyper Protect Virtual Servers and IBM Z to streamline the current healthcare eligibility verification process.

LinuxForHealth

LinuxForHealth is an open source, distributed processing network operating system that facilitates connectivity across embedded devices, fully distributed agent-based, multi-tenant multicloud and LinuxONE distributions. LinuxForHealth is optimized for multiple deployment models and architectures, including arm64, s390x, amd64 and cloud-native. The processing model disintermediates third-party organizations by abstracting the details of health standards, enabling extensibility modularity and scalability — resulting in a developer-extensible trust protocol.

Through its distributed deployment model, LinuxForHealth enables healthcare transactions that support electronic data interchange (EDI) standards (e.g., ASC x12 5010) used to exchange data about health insurance claims, payments, etc. One scenario to which this deployment model can be applied is the current eligibility benefit verification process (x12 270/271) to improve efficiency.

In the healthcare industry, a clearinghouse exists as an intermediary between providers and insurers (payers). While the clearinghouse provides the value of a single entry point for executing healthcare transactions, it adds a degree of separation between providers and payers. For each provider that a patient visits, individual transactions —such as requests for insurance coverage, validation for the necessity of service and determination of co-pay — must pass through the clearinghouse. Because patient health records are typically passed manually and asynchronously between multiple provider and payer systems, this process involving the clearinghouse as an intermediary tends to be redundant, slow and relatively inefficient.

LinuxForHealth offers an efficient, secure and resilient solution to the current flawed process, as demonstrated in this video:

Here, LinuxForHealth provides systems integration across a provider system running on Azure Cloud, a clearinghouse system deployed on IBM Cloud Hyper Protect Virtual Servers and a payer system running on IBM Z to synchronize data across multiple LinuxForHealth instances.   It starts with enabling a single eligibility check with the initial provider that a patient sees. This information that is received or updated is stored in the patient’s longitudinal patient record (LPR). Subsequent request and response messages sent and received between health providers and payers are stored in the same LinuxForHealth LPR and then synchronized across the distributed network. This patient data can then be accessed by other providers, eliminating the need to go through the eligibility verification process over again and increasing access to patient data by breaking down data silos.

IBM Cloud Hyper Protect Virtual Servers

Since the LinuxForHealth LPR allows healthcare providers and payers to share sensitive protected health information (PHI), a secure and confidential computing environment is imperative for this process. That’s why LinuxForHealth runs on IBM Cloud Hyper Protect Virtual Servers. These virtual servers ensure the protection of confidential patient information by providing secure hardware-based trusted execution environments (TEE) and technical assurance that only authorized users can access sensitive data and applications.

The confidential computing environment of Hyper Protect Virtual Servers provides confidentiality throughout the entire compute lifecycle, including data at rest, data in flight and data in use. These virtual servers can equip all healthcare parties involved — providers, payers and patients — with the peace of mind that their patient health information will not and cannot be accessed by external or internal unauthorized parties.

IBM Cloud Hyper Protect Virtual Servers are designed to handle high transaction workloads while providing excellent performance, making them the ideal computing environment for utilizing a distributed ledger and facilitating healthcare transactions. These virtual servers inherit the performance, resilience and scalability of the IBM Z machines on which they run.

IBM Z

Another important element of the LinuxForHealth architecture is the IBM Z platform. IBM Z integration capabilities provide high performance and pervasive encryption security measures across cloud environments. Additionally, IBM Z supports high workload densities, supporting the distributed ledger and healthcare transactions on LinuxForHealth. The modern IBM Z platform supports common tools for product development and automation, such containerization, agile, DevOps, REST APIs and the continuous integration and deployment (CI/CD) pipeline, all of which help developers significantly reduce the time-to-market of products and services. With 99.99999% availability (3 seconds of downtime/year), the IBM Z platform provides the foundation of security and reliability to run cloud applications, and many large insurance providers (payers) currently rely on this platform. This allows LinuxForHealth to seamlessly integrate into current healthcare provider and payer workflows, helping them focus on their area of expertise rather than their IT.

Conclusion

The strengths of IBM Cloud Hyper Protect Virtual Servers and IBM Z — providing security, scalability and reliability, coupled with the distributed data processing model of LinuxForHealth — enable seamless data interoperability between providers, payers and patients that can disrupt the current healthcare system and improve upon existing inefficiencies.

LinuxForHealth is sublicensed by the Linux Foundation with Sublicense ID: 20200615-0008.

Learn more

You can learn more about LinuxForHealth, including its developer setup, application configuration, ecosystem and deployment options here. You can also learn more about the other members of the IBM Cloud Hyper Protect portfolio. IBM Cloud Hyper Protect Crypto Services is a key management service and cloud hardware security module (HSM) that supports industry standards such as PKCS #11. It is the only service in the industry that’s built on FIPS 140-2 Level 4-certified hardware. IBM Cloud Hyper Protect DBaaS offers enterprise cloud database environments for sensitive workloads. This service protects against data-breach threats and data manipulation by privileged users, all while offering the built-in data encryption, vertical scalability and performance features of LinuxONE technology.

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