The health system has created its own data exchange technology and tested it with a regional payer to ensure it meets HEDIS standards.
Providence has unveiled an HL7 FHIR (Fast Healthcare Interoperability Resources) tool that enables seamless data exchange with payers.
The Washington-based health system, which spans more than 50 hospitals in seven states, tested the technology earlier this year with Premera Blue Cross, one of the largest health plans in the Pacific Northwest. Officials say it was vetted by internal teams as well as HEDIS (Healthcare Effectiveness Data and Information Set) auditors.
With the tool, Providence pushes to the head of the pack in the nationwide quest for interoperability through national FHIR standards, alongside federal efforts to develop TEFCA (Trusted Exchange Framework and Common Agreement). The goal is to create a national framework for the exchange of all data between healthcare organizations, health information exchanges, payers, consumers, and other stakeholders, eliminating silos, improving clinical and business operations, and moving the industry toward value-based care.
“Interoperability is critical within value-based care, and FHIR integration allows healthcare organizations to exchange comprehensive clinical data that enables more accurate risk assessments, enhances care coordination and captures outcomes more effectively,” Michael Westover, the health system’s vice president of population health informatics, said in a press release. “By using a national standard for contract gap closure and capturing the much-needed clinical data, we empower all stakeholders in their ecosystem to make more informed decisions, improve patient outcomes and enhance the overall quality of care to our patients – who are always at the center of all our efforts.”
The nation, as a whole, has been struggling to reach interoperability because of the lack of standards for data sets, particularly at a time when the industry is seeing a wealth of unstructured data from sources outside the health system. As a result, few organizations use the same rules to organize and share data, using everything from spreadsheets, fax machines, emails, and secure file transfer protocols (SFTP) to share information.
In an email to HealthLeaders, Westover said Providence is a “trailblazer” in developing data exchange standards that meet HEDIS quality measures.
“We had to wrestle with a new data standard, new technology, and a new data security model,” he said. “We tested for months with our health plan partners and frankly learned some hard lessons as we used a generic clinical exchange standard for a targeted business case. We are now using what we’ve learned to scale the platform with other health plans.”
At Providence, the health system’s data-as-a-service (DaaS) tool leverages the Member Attribution (ATR), Clinical Data exchange (CDex) and Bulk Implementation Guides as national data exchange standards developed through the HL7 Da Vinci Project, which is billed as an industry-led project to enhance data sharing between payers and providers to enable the industry’s transition to value-based care.
A key aspect of the project was securing participation from a payer.
“We initially targeted the clinical data elements for 15 or so clinical measures that have a big impact on patient care and payer finances,” Westover explained. “We were surprised at how excited our health plan partners were and how they immediately asked us to expand the number of included measures and the qualifying patient population in the dataset. Our partners quickly saw the impact this type of DaaS could make on their business during difficult financial times.”
“Payers currently get much of their clinical data from patient charts and from data manually keyed into clunky websites or spreadsheets,” he added. “This solution allows health plans to exchange curated patient data rapidly using a nationwide standard format. If health plans can get higher quality data faster and easier than they could before, they will outperform their competition on important HEDIS, 5-Star, value-based care metrics, and other government programs.”
According to Westover, more efficient data exchange with payers means that providers and payers will have a shared understanding of their patient populations, which in turn will help improve care management and coordination.
Providence executives plan on using the tool to partner with other payers and vendors on data exchange..
“The technological and regulatory environments are evolving so quickly that we expect to see a few different approaches to these types of healthcare interoperability challenges,” Westover said. “Some groups will ask their EMR vendors to take care of it for them. The most successful health organizations will be those that can exchange vital data more efficiently than the rest.”
“The technological and regulatory environments are evolving so quickly that we expect to see a few different approaches to these types of healthcare interoperability challenges.”
— Michael Westover, vice president of population health informatics, Providence.
Eric Wicklund is the associate content manager and senior editor for Innovation, Technology, Telehealth, Supply Chain and Pharma for HealthLeaders.
Prodded by the government through its TEFCA framework, the healthcare industry is trying to develop a framework and standards for the seamless transfer of data from one entity to another.
Providence has developed an HL7 FHIR tool that allows the health system to exchange data with payers.
Nationwide interoperability will enable health systems, payers, consumers, and other stakeholders to easily exchange information, improving clinical and business operations and pushing the industry closer to value-based care.