Healthcare data sharing allows connecting hospitals, insurance companies, third-party administrators (TPAs), patients, and other stakeholders within a single system. When the information transmission efficiency increases, profitability, workflows, insurance reimbursement rates, and compliance also improve. Given that in 2021, US hospitals are projected to lose $122 billion in revenue, optimization is life-critical.
How to implement healthcare sharing? Data interoperability depends on software interoperability. Henсe, you will need systems that follow data interoperability standards, including FHIR. Learn more implementation tips and useful findings below.
What is Healthcare Data Sharing and Who’s Involved
Healthcare data sharing means the consolidation of medical information in a system with shared access. The platform connects personal health informatics, medical, insurance, and healthcare management solutions to join multiple kinds of data in standardized formats. The collected information includes electronic health records, patient registries, clinical trials, administrative, claim, health survey information, and other details. Any entitled party can access this privacy health information based on their health data privacy permissions.
Data sharing capabilities in healthcare systems connect different teams. Physicians use these records to investigate the patient’s history and think about how to improve patient care. Administrative teams rely on shared records to automate billing and record-keeping. Third-party administrators utilize records to process medical insurance claims for hospitals.
The Regulatory Background of Data Sharing in Healthcare
In the US, healthcare interoperability and data sharing stem from regulations. HIPAA and EHR implementation was the first stage followed by the most recent CMS and ONC standards.
HIPAA Age (Health Information Privacy Protection Act)
It all started with the HIPAA health privacy act. In 1996, this healthcare privacy act became one of the federal healthcare regulations governing the medical industry. Although everyone usually stresses that HIPAA aims to promote medical information transparency and security, it also promotes data sharing. The US government passed HIPAA to assure the public that their personal health information is properly protected and accessed. The trust towards medical information processing laid the foundation for effective information exchange between providers and patients. Hence, HIPAA electronic health records were the first significant step towards medical information sharing.
CMS and ONC Age
Over twenty years later, CMS and ONC interoperability data standards in healthcare push information sharing forward. These organizations have established a set of interoperability rules that will come into effect in the next few years. They mandate payers covered by CMS to make patient claims, cost, and specific clinical information available through a patient access API. Payers will also need to follow US Core Data for Interoperability and FHIR standards for data exchange. Apart from payers, CMS and ONC interoperability data standards affect providers and technology vendors. They must have API capabilities for information sharing in HIPAA electronic health records.
Learn more about the Key Healthcare Interoperability Standards and Provisions
The introduction of CMS and ONC data interoperability standards in healthcare, including FHIR, mean one critical thing. Since APIs are used, healthcare organizations will need to cooperate with third-party administrators more closely. It increases the significance of secure software integrations and the overall role of FHIR-compliant TPAs.
Four Benefits of Implementing Future Healthcare Technology With Data Sharing
Data sharing standards, such as FHIR, are critical for TPAs and software vendors that must provide services with decent interoperability. Clinics and health insurance companies won’t partner with TPAs that use non-compliant software. Hospitals, clinicians, patients, and other stakeholders can also draw benefits from healthcare systems with smooth data sharing.
#1. Compliance With Privacy Regulations in Healthcare
Compliance with privacy regulations in healthcare is the main reason to follow data sharing standards. Whereas CMS and ONC standards are only coming into action, HIPAA rules and regulations already entail financial penalties starting from $50,000. Government overpayments, privacy health information disclosure, excessively limited PHI access and sharing are just a few examples of compliance issues in healthcare. And once you ensure the privacy of health information based on secure data sharing and interoperability, compliance should be easy.
#2. Smoother Shift to Value-Based Care
The US health industry is gradually moving from the fee-for-service (FFS) to the value-based care model. Interoperability enables hospitals to collect more detailed information about patients and automatically combine records from multiple teams. As a result, they can reuse existing patient data for a smoother transition and make better treatment decisions, which directly affects reimbursements.
#3. Increased EHR Efficiency
FHIR promotes web patient care technology that enables systems to exchange highly specific pieces of information. Thanks to the XML or JSON format, they can send a test result or medication list rather than entire documents. As a result, EHR systems include better segmented and more efficient information about patients.
#4. Privacy of Health Information
Compliance with FHIR and other health interoperability and data sharing standards requires the use of API. Connecting components through APIs is more secure than using several separate services. It minimizes the risk of information breaches and contributes to health data privacy. Given that in 2020, over 500 US entities were involved in breaches, the risk is higher than ever.
How to Enable Data Sharing and Why It May be Challenging
The implementation of healthcare systems with comprehensive data sharing is problematic both for hospitals and software providers. It requires custom software integrations and a high level of technology and patient care solutions interoperability.
For hospitals and other healthcare services providers:
Most healthcare organizations don’t have in-house tech teams. Hence, when they need to integrate additional capabilities into their EHR system for data sharing, they cannot do it internally. It requires hiring expensive full-time software engineers or outsourcing software integration to an external team.
For TPAs and software providers:
When it comes to TPAs, information sharing gets quite complicated. Whereas traditional healthcare providers list similar software demands, third-party actors often have unique business logic. As a result, they need a compliant information exchange system tailored to their needs. It’s not enough to connect several disparate solutions and set up data sharing. They need complex integration of data management systems, APIs, and custom elements. In this case, ready-made solutions won’t work, and custom engineering is required.
As you can see, the implementation of data exchange systems is tricky. To ensure necessary health interoperability and data privacy in healthcare, you will need to engage professional engineers.
Binariks can help you achieve healthcare interoperability through API integration and connect EMR systems, including Cerner, Epic, E-clinic, Edina help, and others. We have completed numerous healthcare software integrations and launches, including an Electronic Visit Verification Solution and an AWS-based primary care platform. We also have experience with tumor measurement software, remote patient monitoring, primary care, and other types of healthcare solutions.
Today, healthcare data technology and patient care are tightly connected. So how to improve patient care and healthcare efficiency with data sharing?
Follow the HIPAA patient privacy act, CMS, and ONC principles, and they will guide you. Regulatory demands help you optimize EHR workflows and achieve data interoperability in healthcare. When you take steps to avoid a regulatory issue in healthcare, you also improve information sharing, health data privacy, profitability, and patient care.