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Accelerating FHIR Compliance to Provide Patient Access to Information

 

4.11.2023 By Ashley Basile, Ph.D., Chief Product Officer at Availity

 

The modern healthcare consumer wants to take charge of their health by having their medical information at the touch of their fingertips. But gaining access to comprehensive health information as a consumer can be challenging, particularly when the average consumer sees 18 different health professionals across a variety of care settings during their lives.1 And for healthcare service providers, it can be equally difficult to acquire, integrate, use, and deploy member data that is generated across disparate—and often proprietary—information systems.

 

Health Care Service Corporation (HCSC) is the largest customer-owned health insurer and the fourth largest health insurance company in the United States. It serves nearly 17.5 million members, with a network that includes more than 326,000 physicians and other providers, and 9,000 facilities.2 Consider that every year, electronic health records acquire more than 80 megabytes of data from the average patient.3 That creates a lot of data. HCSC is at the digital forefront, revolutionizing the way data fuels their business to drive innovation by investing in ways to tap into the potential of member data to deploy comprehensive data solutions at scale that improve provider and member outcomes and experiences. HCSC are leaders in the development of value-based care models that spur greater collaboration and accountability among members, providers, and the health plan to improve member outcomes while reducing the total cost of health care.

 

Availity and its affiliated companies has spent the last decade leveraging clinical informatics expertise to build one of the nation’s most robust API technologies that ingests, standardizes, and manages various forms of clinical data streams while effectively converting legacy data formats to Fast Healthcare Interoperability Resources (FHIR) in real-time. With unmatched clinical informatics expertise, only Availity generates Upcycled Data™: the cleanest, clearest, most precise data in the healthcare space. Our Availity Fusion engine accelerates the usability of clinical data across health plans, heath information exchanges, and technology partners, as well as supports clinical data compliance with the Centers for Medicare & Medicaid Services (CMS).

 

When the CMS Interoperability and Patient Access final rule established the requirement to provide patients with direct access to their electronic medical records via APIs by July 1, 2021, HCSC had the foresight that the FHIR R4 standard would begin to take root as the new foundational standard to advance healthcare data interoperability.

 

However, HCSC, like many health plans, was challenged by the complexity and coordination needed to standardize and convert massive amounts of legacy data streams into FHIR resources and further deploy clinical data at scale across their business and membership.

 

For example, even though HCSC had access to significant sets of valuable raw clinical data on millions of managed members—from athenahealth and Epic, to lab and ADT data feeds—the company found that up to 50 percent of this clinical data might be unusable in its raw form due to the inconsistencies of clinical data formatting and completeness across electronic health record systems. Clinical data is fraught with quality challenges; a study analyzing data across five electronic health record systems found that 80 percent of allergies aren’t coded appropriately; 70 percent of lab results don’t use the right vocabulary or units; and nearly 40 percent of medications don’t have the right coding for quality measures.4

 

To tap into the potential of clinical data, HCSC needed to be able to integrate multisource clinical data at scale, improve the quality of that data, and leverage the data in a standard format with a shared language across business lines to build powerful data solutions. HCSC built a comprehensive clinical data strategy centered around a new Clinical Data Accelerator program, to position themselves at the forefront of data modernization and insight. To empower members to make better decisions about their health, while reducing the administrative burden for providers, HCSC partnered with Availity to underpin their Clinical Data Accelerator program. Leveraging Availity’s Fusion technology, HCSC converted raw clinical data from all sources into clean, consumable data assets to make this data usable and actionable for Patient Access and many digitally enabled use cases.

 

This scalable, enterprise-level clinical data infrastructure standardized, enriched, and converted >420 million historical data records, including CCDs, HL7v2 messages, and FHIR resources, into over six billion analytics-ready FHIR resources, in under three months. As a result, HCSC was among 5 percent of health plans across the nation who were fully compliant by July 1, with the CMS Patient Access mandate. In addition, HSCS’s Clinical Data Accelerator program was recognized as a semifinalist in Gartner’s Eye for Innovation Award for the innovative use of technology-enabled capabilities in improving health, costs, and efficiencies, and applying emerging technology.5

 

HCSC’s Clinical Data Accelerator program continues to flourish, now providing over eight billion high-quality FHIR resources to power many enterprises use cases. Benefits include accurate HEDIS® quality reporting, reduced chart chases, enhanced value-based care modeling and care management, effective provider network management, and improved prescription management. Based on this initiative’s innovative and strategic opportunity, the Clinical Data Accelerator program was awarded “Most Critical Project for 2021” by HCSC’s leadership and continues to be an area of significant growth for one of the country’s largest national health plans.

 

We could not be prouder of our strategic partnership and success in accelerating the use of high quality FHIR data across the HCSC enterprise. If you are interested in learning more about how HCSC upcycles its clinical data with Availity, checkout the case study here

 

1Vimalananda, Varsha G, et al. “Patient, Primary Care Provider, and Specialist Perspectives on Specialty Care Coordination in an Integrated Health Care System.” The Journal of Ambulatory Care Management, U.S. National Library of Medicine, 2018, https://www.ncbi.nlm.nih.gov/

2Marco D. Huesch, MBBS, and MD Timothy J. Mosher. “Using It or Losing It? the Case for Data Scientists Inside Health Care.” NEJM Catalysthttps://catalyst.nejm.org/case-data-scientists-inside-health-care/.

3“Who We Are.” HCSC by the Numbers | Health Care Service Corporationhttps://www.hcsc.com/content/bcbs/hcsc/en/home.html

4D’Amore et al. Using Clinical Data Standards to Measure Quality: A New Approach. Applied Clinical Informatics. 2018.

5“Eye on Innovation Awards for Healthcare and Life Sciences.” Gartnerhttps://www.gartner.com/en/about/awards/healthcare-eye-on-innovation. 

 

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