Sharing your health data: when systems speak the same “language,” care gets more efficient.
Doctors, hospitals and health insurers are getting closer to the ability to share patient health and insurance claims data across systems, in real time. And here’s why that matters:
- Sharing data means that when you visit healthcare providers in different settings you get more coordinated care.
- It means health insurers can help doctors understand, right away, how to use your member benefits.
- It means doctors and insurers can work together to follow up with patients who may benefit from more outreach.
- It could mean saving money by avoiding duplicate care.
- And, it means patients will have access to their own health data.
Blue Cross of Idaho working to provide you access to your health data, where and when you need it
This future state--the ability to share data, seamlessly, between one healthcare setting to the next, in real time—won’t be easy to reach. Healthcare providers, health insurers and others use different electronic systems to store this information. Those systems often can’t “talk” to each other because each uses different data fields and so much new health data is generated every day.
But Blue Cross of Idaho is laying some major groundwork to get to this future state. “Our ultimate goal,” says Lance Hatfield, Blue Cross of Idaho’s Chief Technology Officer, “is to be able to make sure you have access to your information in any setting.”
Helping healthcare systems speak the same “language”
Hatfield says Blue Cross of Idaho began by upgrading its member smart phone app. The app now uses a “language” that more and more health systems will be able to understand. “That gave us an opportunity refresh our infrastructure,” says Hatfield, so that Blue Cross of Idaho will be ready to implement this language, called Fast Healthcare Interoperability Resources (FHIR), across other parts of the business.
Real world examples: prior authorizations and Explanation of Benefits (EOB)
When Blue Cross of Idaho and more of the doctors and hospitals are using FHIR, possibilities open up to make data more useful, often right in the doctor’s office. Hatfield gives these two examples:
- Faster decisions on prior authorizations. Today, says Hatfield, if your health plan requires prior authorization, or approval, before a doctor can perform a procedure, order medical equipment or prescribe a certain drug, you might have to wait on an answer. When health insurers and doctors are able to exchange data in real time, a decision on a prior authorization could be made much faster with lower administrative burden. “Using the provider’s electronic health record,” says Hatfield, “patient and doctor could have an answer at the point of care.”
- Simpler billing process. After a doctor visit, you may get a bill from the doctor. But it’s probably not the final bill. It might simply be an estimate of what you’ll owe after your health insurer pays your claim. Your health insurer might then send an “explanation of benefits,” or a read-out of what part of the bill your insurer covered. After that, you’ll usually receive a final bill from your doctor letting you know how much is left for you to pay. Hatfield says using FHIR could potentially mean you’ll just get one bill or request for payment from your doctor, because the math has been worked out much faster, behind the scenes.
Blue Cross of Idaho is a founding member of Da Vinci, an industry group focused on making sure healthcare providers and insurers adopt the same “language” to make sharing data as meaningful and easy as possible. Hatfield says that cooperation, even amongst competitors, will benefit patients and make data sharing a reality more quickly.
Blue Cross of Idaho is a licensee of the Blue Cross Blue Shield Association, an association of independent, locally owned and operated Blue Cross and Blue Shield Companies.