As a server of medical accounts, agencies often find themselves facing some additional technology concerns. Every vertical brings its own technological challenges. In most verticals these challenges are shared but the healthcare vertical adds complexity when considering items such as system of record and the detailed nature of industry accepted data standards.
Medical collection software exists for any serious agency in the healthcare space. However, I see and hear agencies are simultaneously working in two different systems, their own collection software and the hospital’s system. (Throughout this column, I will repeatedly reference the “hospital’s system” but the terms “medical facility’s system,” “insurance company’s system,” “claims management system,” and so on could easily take its place.) The questions I will address in this column are: Why are there disparate systems and how can these agencies work out of one system? Most often the “why” is one of three scenarios. One, the hospital requires the agency to work directly in their system. Two, the agency software does not have the same data points as the hospital’s system. Three, there is no seamless integration between the two systems so real-time updates are not sent back and forth between the two pieces of software. In any case, system of record becomes a question. When working in two separate systems, which one wins when there is a conflict? No wrong answer to this question exists and the better question to answer is how can the conflicts be avoided? Unless you have a compelling case, the hospital will insist your reps work directly in their system and will not be convinced your receivables management software is sufficient enough to allow otherwise. You can utilize your technology to build this compelling case by addressing the integration scenario previously presented.
Before detailing a seamless integration between systems, there are a few prerequisites. Ideally, the following statements are all true:
• Both the agency and the client have technical teams available to implement and test the integration.
• There are application programming interfaces or web services available for both the source and target systems.
• The source and the target system include functionality to track data changes and events that occur as users are working.
Consider your collection software as the source. This is the system you are familiar with and the system you prefer to work with. A data push can be developed using system inherent data integration tools or an external data integration tool with connectors to the system database. This push process will need to be constructed in a manner that captures the data level events as they occur and will need to be shared with the hospital’s system. Simultaneously, a pull or retrieve process will need to be in place for the hospital. This process will grab the real-time data events being provided by the agency’s system. After some analytic, transformation, or validation routines are performed, the data from the agency’s system will ideally auto-update in the hospital’s system. Additionally, reverse processes will need to be engineered for the hospital to automatically share real-time data events with the agency’s system. Achieving this sort of real-time integration will allow your representatives to work exclusively in your system while keeping the hospital’s system in sync and vice versa.
Prior to engineering the solution described above, there will need to be a requirements gathering session with your client to identify the data elements that are important to share and are able to be shared between the two systems. A significant takeaway from these sessions needs to be a requirements document. At a minimum, the following should be detailed in this documentation:
• A very detailed listing of the data fields to exchange.
• Any business rules related to data transformations, data validations, and data extract/load procedures.
• Instructions for using any web service technology.
Utilizing existing data standards is almost essential in the healthcare space. These standards are also helpful in achieving real-time system integration. Your agency is likely already using data standards like Health Level Seven (HL7), HIPAA formats, or something EDI related in order to exchange data with clients. Transaction and code standards like these provide a uniform method for sending and receiving healthcare related data in near real-time. It is important to understand these standards not only because your clients will expect it but also because it displays a higher level of sophistication regarding your operation. The client’s only expectation is you are staying up to date with the ever-changing healthcare standards. The October 1, 2015 countdown to ICD-10 (10th revision of the International Statistical Classification of Diseases and Related Health Problems – Clinical Modification/Procedure Coding System) is on the horizon. Are you ready?
Sam Edens has been with Emprise Technologies since 2006 and is currently serving as Vice President.