The importance of Healthcare Information Exchange (HIE) is at an all-time high that is continually evolving to improve the quality and timeliness of care for patients. Access to medical records gives those providing care an understanding of the patient’s health history. Typical information that can be found in a primary care medical record includes but is not limited to:
- Preventative therapies
- Demographic details
- Biographical details
- Significant illness
- Chronic conditions
- Lab results
- Hospitalization specifics
Providing accessibility and understanding of this information across all provider types at critical times allows a physician to obtain knowledge across the board regarding the patient to make the best decisions for his or her health. The electronic medical record (EMR) has been embraced by many and supported by the Centers for Medicare & Medicaid Services (CMS), providing available access to share needed information in compliance between provider and health plans within Health Insurance Portability and Accountability Act (HIPAA) standards.
Not only are medical records important to physicians, but they also play a crucial role to health plans. A health plan is tasked with ensuring all physicians, in and out of network, are caring for members with optimal quality. This is most commonly done through processes governed by CMS such as the Healthcare Effectiveness Data and Information Set (HEDIS®), Star Ratings, and risk adjustment. Specific to risk adjustment, medical records allow health plans to ensure the risk of members is appropriately calculated and fully supported by a valid medical record that could withstand a risk adjustment data validation (RADV) audit by CMS and/or the Department of Health and Human Services (HHS).
Unfortunately, there have historically been several barriers to the effective exchange of health information between plans and providers, including:
- Provider participation/consent
- Management of unstructured data
- Viability of existing file formats for risk adjustment
Therefore, it’s important to ensure your organization is addressing these areas when launching an HIE initiative. One leading health technology company, Ciox Health, recently launched a multimodal clinical data acquisition and aggregation solution, called HealthSource,that tackles these traditional barriers. Ciox’s HealthSource leverages both the shift to collaborative value-based contracting and the company’s existing trust foundation (as the largest release of information services vendor for providers) and employs automation, including natural language processing and artificial intelligence, to expedite authorized clinical information exchange. As clinical information can be found in both structured data (demographics, lab values, etc.) and unstructured data (medical records images), Ciox applies technology-based processes to enable conversion to structured data to create a unified member-centric data repository. Further, as the largest intermediary of HIE, Ciox has worked closely with leading EMR vendors to ensure the records themselves contain the requisite chart elements to support risk adjustment and other health plan uses.
In an announcement recently released by the company, CEO Paul Roma stated, “We believe that when clinical data can move easily and transparently between stakeholders, the entire health system works better, and most importantly, doctors and patients benefit.” Roma said the new suite of applications is meant to integrate “advanced and highly secured technologies into authorized medical data sharing operations,” offering healthcare organizations an improvement over the “costly and obsolete way health information is accessed and consumed today.”