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POSTS BY TAG | health data

Healthcare Interface Integration, a three-way tango


IT TAKES TWO TO TANGO BUT THREE TO INTERFACE


While dance shoes are not required, implementing a health care interface, especially one that can smoothly share data between two systems, can be as intricate as a three-way tango. The partners you choose to dance with can make all the difference. Who will lead? What special talents does each dancer have?  How do we put together a winning routine?

Small & Mid-Sized Practice Management System Vendors More Responsive

Here at pMD, we have worked with every imaginable type of system vendor from small mom-and-pop shops to huge national organizations. There is no hard and fast rule, but in many cases, the benefit of working with small and mid-sized organizations is that more often than not, they’re more responsive and eager to satisfy the customer.

While it seems like everyone may get overloaded, in my experience, working with a smaller vendor actually often means you have access to the people who can make decisions and get them implemented.  Want to add a more complicated dance move to your routine?  With a small-to-midsize dance partner, often you can just easily ask for help with that and it gets done. 

Delays Common When Working Alone with Large Vendors

With a larger one, a request for a new feature may get taken by your account manager, then relayed to a technical analyst who in turn has to get approval from a committee. Then, if it gets approved, you may find out that the dance partner does not even know how to carry out that complicated dance move. Too many dancers on the dance floor can lead to a spotty routine!

pMD has a long-established, reliable interface with a very large and major vendor, making it easy to implement for new practices joining pMD. Groups that are new to pMD and that request this interface can often get it implemented in a matter of days. Which is great, right?

Recently, a few practices with this interface asked about leveraging a new feature in their practice management system. The other vendor was unwilling to enhance the existing interface and insisted on making it a brand new project. On our end, we were able to make the requested enhancements in just a few days but somehow ended up spending months trying to get a new connection up and running in order for us to send that additional data over to the vendor's system correctly. While this isn’t always the case for all large vendors we work with, this tango, unfortunately, fell short. 

Working With Responsive Vendors Results in Faster Implementation

In working with many small and mid-sized vendors, we’ve found that the person we are dealing with is the actual interface designer and developer. Projects like these can often go very smoothly due to that close proximity. In a recent project with a mid-sized systems vendor, the interface engineer was reliably on every status call, creative about addressing special requests from the practice, and prompt in following up. The customer was able to go live in about a month with a customized interface that addressed their needs. Here, the tango routine wowed. 

Charge Capture Interface Implementation a More Challenging Project

If you’re unfamiliar with interfaces, just know that different types of interface projects have different degrees of difficulty. For example, there is very little variation in setting up patient demographics interfaces from one vendor to the next.  However, when it comes to charge interfaces, or sending charges from one system to another, they prove to be a little more challenging, take more time, and require more testing. In other words, the dance routine takes more practice and finesse. 

Interface Implementation with Vendors & Customer Working Together

While we at pMD and your practice management system vendor or hospital IT department are the dancers that have to agree on the moves, the dance routine cannot go anywhere without that third partner, the customer. The customer helps keep the tempo and encourages us vendors onto our feet, pushing us to dance through the routine without stopping. Keep us on-beat and you’ll find the dance slowly unfolding as a thing of beauty - an interface that will wow the crowd.

To find out more about pMD's suite of products, which includes our MIPS registrycharge capturesecure messagingclinical communication, and care navigation software and services, please contact pMD.
Interoperability of health data


 

HERE’S WHO DID WHAT TO ME: COMING REGULATIONS SUPPORTING INTEROPERABILITY FOR HEALTH DATA


With the creation of MyHealthEData, and through current rulemaking, the Centers for Medicare and Medicaid Services (CMS) is pushing significant new data-sharing requirements into the market.  The new rule opens all types of doors in its effort to improve data transparency and data velocity throughout the system.

The core tenets are:

Ensuring patients have access to all health data where CMS has programmatic authority:


Any payors involved in the following programs are required to have open APIs (Application Program Interfaces): MA organizations, Medicaid programs (both FFS and managed care), CHIP (including FFS and managed care), and QHP issuers in FFEs.

These open APIs will allow patients to empower a vendor to access their claims, encounter data, utilization history, and any clinical health information (such as lab results when available) the payor may have. Payors are also to make their plan directory available through these APIs and have to share care coordination data with each other.

Electronic patient event notifications:  


As a condition of participating with Medicare and provided their EHR has the ability to produce and send an Admit/Discharge/Transfer (ADT) message, it is being proposed that hospitals should send notifications to those practitioners or providers that have an established relationship with the patient relevant to his or her care. (The requirement is waived if the receiving provider can’t receive such messages.)

Prevent information blocking:  


Providers who are not making patients’ clinical data readily available will, essentially, be publicly shamed into compliance as CMS aims to share provider attestations that the provider complies (or doesn’t) with interoperability requirements laid out in updated MIPS rules.  In my opinion, this is a seemingly weak penalty for non-compliance so hopefully, CMS tightens this to improve accountability.

So how might care be impacted by these changes if implemented largely as proposed?  


Where are patients likely to engage with this information?  How about providers?

Patients, to date, have shown little interest in actively engaging with their health care data on their own (consider almost every provider’s struggle to get Portal engagement) - what will Medicare/Medicaid patients do with their claims history?  It’s possible applying algorithms to claims data to identify at-risk profiles might generate patient-level demand but the marketing will have to be focused and on point.  

The first real-world test of the data typically available is Medicare’s Blue Button API (now in version 2.0).  As of October, there were 1,200 software developers in the sandbox and 100 - 200 patients had downloaded their data.  It’s possible this gap between developer engagement and patient engagement represents a lag from the time it takes to create an application to generating demand for the information.  I think it also highlights that age-old health care problem of an abundance of data and little of it valuable or comprehensible to your average individual. At the end of the day, how do you engage a patient to make their best health care choices when those choices are either deeply complex or rarely and erratically occur?

The other audience, of course, is providers.  Claims data provides a history of activity which can complement the clinical care history each participating provider can access.  They can see diagnoses and procedures which both carry useful information in any given provider’s ongoing care of the patient and supplement their clinical inquiries.

The second benefit of having access to claims data is in optimizing HCC scores.  Since a primary input of HCC scores are all the diagnoses a patient accumulates during the year, having access to a comprehensive list of billed diagnoses allows for any given provider to potentially optimize the patient’s HCC scores.  If this market evolves, payors could fully decentralize HCC scoring (with appropriate incentives) to providers. Considering the HCC score paradigm is national, and zero-sum, it can be expected there will be a rush to claim this space and a handful of winners should emerge.

The health care market continues to be pushed to evolve as the population ages and inflation marches on.  You should consider the technology companies you work with and ask if they have the history, the people, and the capabilities to help you navigate a market where changes can dramatically impact your bottom line and your outlook.  At pMD, through our expertise in mobile charge capture, secure clinical communications, and care navigation we strive to meet our customers where their future needs live.  See what we are about at www.pmd.com.

Related Articles:

Interoperability in Health Care IT: The New Norm… Eventually
The Goal of Interoperability in Health Care: Uniting People & Systems


To find out more about pMD's suite of products, which includes our MIPS registrycharge capturesecure messagingclinical communication, and care navigation software and services, please contact pMD.