Interoperability: The Cornerstone of a Quality Healthcare Experience
Just think: If there were a magic pill to alleviate many of the challenges within the complex inner workings of the healthcare system, would you take it?
If so, that would be one mega pill to swallow.
Although there’s no one antidote to totally treat the issues that are bound to occur in such an immense industry structure, solutions are available today to help restore the health of these vast systems. Interoperability is one of the most promising of these solutions.
According to IBM, interoperability is “timely and secure access, integration, and use of electronic health data so that it can be used to optimize health outcomes for individuals and populations.”
Interoperability Challenges in Healthcare
The path toward achieving interoperability involves so many different, yet equally important, programs, systems, people, and services. Without interoperability, all those different health systems cannot exchange or use health information. This impacts both healthcare providers’ abilities to care for patients and patients’ abilities to have seamless healthcare and financial experiences.
Interoperability is an important facet of healthcare operations, but far too often, providers face significant challenges in making it work effectively. Surmounting those challenges is critical in an increasingly competitive healthcare landscape. Though frequently overlooked, interoperability is critical to the overall financial success of physician practices and the comprehensive experience of patients.
The challenges are spread among several key areas, including knowledge gaps, whether in terms of documented procedures or well-trained integration technology staff. Another challenge is the lack of interoperability standards or even the careful enforcement of existing ones. There can also be variability between electronic medical records and protectionism. Still, competing priorities for IT and an integration of resources making a difficult situation even more precarious presents challenges, too.
But you must attempt to face these challenges head-on. Both patients and providers have so much at stake. Interoperability touches many key areas of healthcare and has a vital role to play in the financial experience. It provides an opportunity to reduce friction, physician charge lag, and the overall cost of healthcare.
Great systems that provide reliable and effective interoperability are the quickest way to reduce significant costs in the billing process. Such systems can also lead to the reduction of denials and patient billing escalation. Everything is also more scalable and agile than manual processes.
The past two years have shown that providers who have efficient digital solutions in place can adapt far more quickly to changes than those who rely on human-driven processes. Efficient digital solutions are no longer just “nice to have” — top-notch interoperability systems are a key competitive advantage in healthcare.
Let’s take a closer look at two of the main areas affected: the patients’ and the providers’ financial experiences.
Why Interoperability Matters in the Patient Experience
Without top-notch interoperability, patients may have disjointed and diminished healthcare financial experiences. One key area is billing. When interoperability is subpar, patients are likely to endure increased costs, squandered time, and the unpleasant effects of confusing billing. There can also be significant billing delays, a lack of transparency about how billing works, and errors related to the manual entry of medical codes and charges. That all adds up to a major disincentive for patients, causing them to be less likely to seek necessary medical services.
Another issue is patient safety. When clinical information is not readily shared between health systems — when the right hand doesn’t know what the left hand is doing — potentially grave mistakes can happen. This is even more likely now when patients can be on multiple medications, given that medications can have negative interactions. Robust, effective, and immediate sharing of clinical data between providers is critical to providing the highest quality care. When a lack of clear, reliable interoperability is a roadblock to this important goal, patients can be at major medical risk.
Why Interoperability Matters in the Provider Experience
When interoperability is riddled with inefficiencies, providers also suffer. In fact, providers without effective and headache-free interoperability face an increased risk of burnout due to working more to compensate for the inefficiencies that poor interoperability causes.
For example, without proper interoperability, there can be a significantly increased cost to collect for medical services. That decreased revenue per patient will then cause the provider to work with higher patient volumes to maintain the same income stream, which can burn out providers who are already working near exhaustion.
Providers also face pain points in manual entry errors, delays in charge lag and relative value unit reporting, and increased billing staff. Manual processes really should be avoided whenever possible because they introduce more potential points of failure and security risk (such as protected health information breaches, ransomware attacks, and other issues.) Some providers are also still physically mailing and faxing patient information, which could mean significant billing delays and escalated risk of exposing confidential patient information.
Why Interoperability Is Still a Work in Progress
Organizations often leave interoperability in a state of partial resolution due to several factors, including a lack of standardization with EMRs and incentives to invest in interoperability, that complicate its completion. At the same time, it is usually quite difficult to quantify the impact of interoperability shortfalls (such as denials, errors, and reworking due to inefficient processes.) Many large EMRs are built on antiquated technology, making them complicated and expensive to upgrade.
Fortunately, high-quality interoperability is within reach. To undergird any such renovation, keep the importance of interoperability in mind: getting the right information to the right resources at the right time.
Zotec Partners is equipped to address these challenges in several ways. Because there can be significant differences between physician versus patient attitudes toward various digital healthcare technologies, let’s first look at patient experience solutions.
Front-End Solutions Serving the Patient
Establishing good patient engagement from the very start of the patient’s healthcare experience is one key part of the overall interoperability puzzle. The best way to do this is to integrate engagement into the registration process. By adding an effectively constructed patient portal for registrations, you can gain all necessary patient information before the visit, and the information will often be more accurate.
An effective patient portal is only the beginning, though. Patients want to be able to check their health records online easily. That system should be intuitive and employ best practices for patient cybersecurity (including optional two-factor authentication). Record updates should also become available on the patient portal automatically.
A great patient interface is a vital part of the equation and can be created through contracted integration development groups, which help organizations that don’t have the necessary in-house resources. Unfortunately, organizations will either need to consult the group for further support or hire in-house staff once it has completed a project.
Back-End Solutions Serving the Provider
A large amount of information is transferred through the back end of a healthcare system. Getting these details right can make an enormous difference in the efficiency, profitability, legal protections, and quality of care that providers can experience and deliver.
One important issue is finding an EMR that supports interoperability. Many EMRs and hospital systems are moving toward Health Level Seven integrations. HL7 integrations are international standards that provide guidance on transferring and sharing data between different providers. Selecting a process with excellent features is vital. Although it may present an initial expense increase, it will be well worth the price as it prevents serious hassles and long-term manual costs.
You’ll also want to seek out electronic workflows to support the business. You’d be surprised by how many electronic workflows used with EMRs are not built with all downstream systems in
mind. Instead, organizations generally build workflows only for the clinical aspects of healthcare and tend to omit the critical puzzle piece of billing.
The only way to get consistent and reliable results from interoperability is to carefully consider billing workflows when making changes or integrating a new platform. Set aside time for planning. There will always be compromises and corners to cut, but understand that the more you sacrifice, the more challenges you guarantee for your team down the road.
The Zotec Difference
Zotec is aware of this crucial issue, and we design our systems to provide the right mixture of coverage for both the clinical and medical billing aspects.
For example, our systems are broadly receptive to many different file types. We can accept HL7, flat files, images, PDFs, and other formats. By investing in new tools, such as optical character reading technology for processing incoming documents, we speed up the paperwork handling.
Our team of experts has valuable experience in various EMR and integration technologies, allowing us to support our clients better and help them optimize processes.
Zotec has developed effective solutions to several technical issues in the quest for seamless, effective interoperability. One issue is electronic interfaces. Of course, the data captured in these structures are only as good as what people enter into the system, but it’s still crucial to use the most appropriate data structures.
Our approach to data extraction is also first-rate. If an EMR cannot provide the data through a standardized interface, custom reports or database extraction can pull the information and present it in an electronic format in some cases. That process saves providers time and effort because creating, testing, and supporting this process manually can be very time-consuming.
We also provide a great set of application programming interface, or API, connections, which can often be challenging for a healthcare provider to secure due to the current state of this issue. For instance, some EMRs offer direct API connections to allow bidirectional communication between the EMR and vendor. This communication allows vendors to bridge the gap where registration issues may occur later in the process. Only a few large EMR vendors currently support these types of connections.
Sometimes, healthcare providers’ information security leadership is unaware of or uncomfortable with API connection implementation. Zotec is not only aware of all the issues in this domain, but we also prioritize interoperability APIs. For example, our implementation and adoption of API interfaces allow medical billing systems to communicate in real time, an approach that is likely to be industry standard.
We also recommend moving to standardized electronic data workflows. This would require using a standardized dataset for higher speed and greater reliability, as such standard datasets are readily available from online resources. Presently, some systems do not support sending these values, but that is likely to change. Standardizing process workflows across the EMR also helps identify valuable information to improve data integration.
Carrier standardization is another keystone concept of interoperability. If organizations could agree on a standard dataset of carriers and adopt it into most EMRs, along with the ability to add others as needed, it would significantly improve carrier matching and reduce the ambiguity of descriptors or proprietary identifiers. With so many carriers, organizations would likely need to create others on an ad hoc basis. However, organizations can manage this with careful oversight.
Why Zotec Partners Is the Right Choice
Zotec is on the cutting edge of all issues with healthcare interoperability. With a highly experienced team of diverse, skilled professionals, we are familiar with essentially all major electronic health records, client custom systems, and data.
We are also experienced in the adoption of interoperability processes, from transport to translation to validation. Our years of experience have taught us always to consider interoperability as a matter of critical revenue integrity. For those reasons, we have crafted proprietary solutions to optimize interoperability and revenue cycle management for healthcare providers.
Furthermore, we know that interoperability is not just a technical challenge. It’s also a matter of organizational buy-in. The organizations implementing EMRs and associated workflows should be conscious of how their decisions in the setup process will impact their output. Ask the right questions of your integration team members. Check that they and others are working in concert to provide the best final product. After going live, having organizational buy-in on the workflows will only help keep the process happy and healthy.
For more information, reach out to Zotec Partners Sales and Client Services.