healthcare interoperability

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Healthcare Interoperability


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Interoperability with a FHIR-based Patient Access API

healthcare interoperabilityA FHIR-enabled patient access API for interoperability allows multiple healthcare systems, applications, and devices to securely access, integrate, and exchange health data. It not only facilitates portability and healthcare consumerism, but it also provides critical data at the point of care to optimize patient outcomes.

Today, ONC and CMS are driving the development of interoperability standards, with input of industry groups, to ensure access and transfer of electronic health information (EHI) data from multiple health IT systems. As a result, a patient's clinical, demographic, and claims history can be seamlessly accessed – with the individual's consent – by payers, providers, patients and healthcare IT services organizations using the FHIR-based data format. Easy retrieval of and access to a more comprehensive view of a patient’s data through interoperability helps improve care delivery, reduce costs, and promote a better patient experience.

Interoperability Improves Patient Care

The primary goal of new healthcare interoperability standards today is to drive value-based care initiatives by integrating enhanced patient data into workflows. In addition, interoperability allows patients to connect all the pieces of their medical history from one source to another. Meaningful use of healthcare data and interoperability between multiple health IT systems (e.g., EMR, claims systems, care management platforms) is critical to not only patient care, but their overall experience.

Here are a few examples of how clinical interoperability benefits our healthcare ecosystem:


Robust Patient Data Access Benefits Both Payers and Providers

Payers and providers need to have access to a patient's complete medical record, including medication lists, previous or existing care plans, laboratory tests and results, as well as hospital admissions, discharges, and transfers (ADTs). With this data, they can make more accurate medical decisions without duplicating procedures and tests. Payers need ease of access to patient data for member onboarding, to identify potential gaps in care, and for coordination of benefits for members. With over 240 payers and thousands of providers with FHIR patient access APIs, LexisNexis Risk Solutions offers the most access points to these APIs.

Healthcare Interoperability Reduces Errors and Administrative Costs While Increasing Margins and Efficiency

Without interoperability, technology resources are used to create and maintain multiple API connections and coordinate data exchange. Instead, with the electronic exchange of already orchestrated data in a FHIR-enabled format, data is seamlessly incorporated into a patient's chart, mistakes are minimized, and staff output is maximized. As an experienced FHIR partner, LexisNexis Risk Solutions builds and maintains thousands of API access points, allowing developers and other technology resources to focus on leveraging this data with a single API connection, which reduces variations in the data across the ecosystem.

Data Integration with Most Health IT Data Sources Allows Building Agile, Efficient, and Cost-effective Healthcare Systems

Our FHIR-enabled Patient Access API makes it easier for payers, providers and other entities – with patient consent  to access critical information from medical claims, pharmacies and clinical settings. Patients and healthcare providers no longer need to waste time filling out basic admission details on each visit and can access data that has already been captured. In addition, LexisNexis Risk Solutions enriched Patient Access API can incorporate Social Determinants of Health (SDOH) risk and contact information to enhance personalized patient care.

Mitigates Physician Burnout

More and more physicians have been tasked with collecting care-encounter data while at the same time having limited access to complete and/or accurate patient data on which to base their care decisions. Interoperability allows providers to easily access data from other systems across care settings to create a more holistic patient profile, thus reducing the burden on physicians and their staff to collect additional data related to the patient’s care history.
Learn more about advanced analytics and health provider data governance for patient care in this white paper.

healthcare interoperability

Benefits for Patients

Better Quality of Care

Because individuals experience different clinical diagnoses, patients may go to a series of care settings, independent practitioners, or hospitals to support their care. Every individual interaction with a care provider adds to the patient’s unique medical history. Not having access to a comprehensive patient profile due to the lack of integrated health IT systems and data ishealthcare interoperability not only inconvenient for the patient, but it can also be prone to errors and result in lower quality care. Complete and timely access to personal health records (PHR) dramatically enhances the quality of care each medical professional can provide.

Interoperability also provides patients more control over their medical data allowing them to make more informed decisions for better health outcomes. Through these new ONC regulations, patients are in control of their personal health data with the authority to give consent to share their data, thus creating a truly member-driven, patient-centric system of care.

Interoperability Advantage for Payers

Stay Competitive and Facilitate Growth and Expansion

healthcare interoperabilityIn the highly competitive healthcare space, payers must make informed strategic decisions about new markets, products, and trends while negotiating better contracts, identifying potential risks, and increasing operational efficiency. None of this is possible without access to the structured data and analytics around patients and providers in their network.

With interoperability, payers – with a member's consent – can gain insight into a member's medical history or the provider networks of competing plans. Interoperability can also reduce data duplicity and repeat tests which reduces unnecessary or ineffective care and the resulting medical claims submitted for that care. This enables payers to help ensure their members receive the most effective and cost efficient care possible.

Challenges of Healthcare Interoperability

healthcare interoperabilityData security remains the most important priority for clinical interoperability as more patients begin to leverage technology to access and share their health data. The healthcare industry is a hot bed of cybersecurity attacks and data breaches as hackers continue to monetize the personal health information they steal at record levels.

Another challenge with achieving robust and accurate health information interoperability is the amount of inaccurate data within medical records and patient health information. Health data exchanges and APIs enable appropriate and secure data access using the FHIR format. Still, multiple analyses have shown that much of this health data contains errors during data collection like wrong date of birth and incorrect name spellings.

This information passes through numerous systems through database and system integrations. Healthcare entities may need a hub and spoke data model for EMR data integration from data collection to distribution.

LexisNexis Risk Solutions provides healthcare organizations with a single Patient Access API integration point to securely access, clean, standardize, and enrich data captured across EMRs, and other health information systems. Our solution offers consistent, clean information across every participating network of payers, providers, healthcare IT organizations and patients.

We can help your organization predict and manage risk across industries and ensure compliance with government mandates.

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Connect with a LexisNexis Health Care representative today to learn how your organization can achieve
greater accuracy and efficiency through secure and interoperable health data exchange.
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