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Inside out: Internal system modernization should consider external data exchange

By Don Johnson posted May 12,2020 06:15 AM

Don Johnson, CTO and Vice President of Product for State Government, Optum

Inside out: Internal system modernization should consider external data exchange

As we all know, there is incredibly important work being done to contain the spread of COVID-19. Work such as predicting the next surge in infections, and tracking medical equipment supply and demand. All of these efforts rely on data from many different sources. And it’s not just the data that’s valuable. It’s the ability to share that data in a streamlined, interoperable, and effective way.
While recent events have put a spotlight on data exchange, it has long been important. Organizations that can swap knowledge with other groups are able to uncover critical insights that inform treatment plans, support coordinated care and determine program eligibility.
There are several factors to weigh when considering plans to modernize internal systems. One that should be high on the list is external data exchange standards.
Earlier this year, the Centers for Medicare and Medicaid Services (CMS) finalized a rule designed to improve clinical information exchange using HL7’s Fast Healthcare Interoperability Resources (FHIR) standard. Take a deeper dive on this new rule and how it impacts data standardization in our latest white paper. Previous HL7 standards improved data interoperability on the claims side. This new rule addresses electronic medical records and could positively impact patients, providers and payers.
For state CIOs, developing an understanding of the standard can support smart choices when working to modernize a legacy system. And with each decision, they can go back to the question, ‘will this change support my ability to seamlessly share data?’
The answers can help determine what capabilities to seek out in a replacement system, modern interface or integration layer.
Ensuring system modernizations are based on this and other common standards will allow data to flow freely. Agencies will achieve the data quality and scale needed to support advanced analytics and techniques like machine learning, deep learning and automation. These tools deliver insights health care leaders need to make sound decisions and close costly gaps in care, including:
  • Poor coordination of care — resulting in an estimated $27.2 billion to $78.2 billion in wasted spending[i]i
  • Missed diagnoses
  • Duplicative labs and diagnostics
Systems that are able to integrate with other platforms and applications will make it easier to combine clinical data with claims data — a huge move forward in the effort to create the whole-person view needed to better serve individuals and understand populations. We will no longer miss out on the bits of information leading up to a reimbursement event.
Modernized systems with a solid data foundation based on standards will also support the development of advanced analytics for analyzing data. By providing consistency of data meaning and structure, standardization reduces the burden of training and data preparation for machine learning or data learning models.
Data standards will also allow for integration across agencies, which could enrich efforts aimed at improving care through a deeper understanding of all of the factors that affect an individual’s overall health. Those insights can help states define needs and develop services or platforms better suited to their populations.
The new FHIR standard can bring about a more efficient, integrated health system — one that supports health care leaders working to serve all involved and ultimately lead to better, more coordinated care. The result will be a whole-person view: one that would benefit patients and providers at all times, especially in situations like COVID-19, when it’s so important to easily view all underlying conditions and offer the most effective care.