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Interoperability and Its Impact on Healthcare Revenue Cycle Management

What is Interoperability?

Interoperability is the desired state where disparate systems used in healthcare are able to work together. HIMSS offers that “Interoperability describes the extent to which systems and devices can exchange data, and interpret that shared data” and adds “For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user” (HIMSS, 2018).

Why Is Interoperability Important?

Interoperability will enable any authorized physician to securely access all clinical chart data regarding a patient, no matter what other physicians the patient has seen, when those visits occurred, and regardless of which EHR system those other physicians were using (Howard, 2018).

For healthcare, interoperability is vitally significant in the effort to improve outcomes. It requires the multiplicity of “information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged” (HIMSS, 2018). The different systems apply to working environments involving various clinicians, the laboratory, a variety of hospital departments, transitions between care environments and modalities, and external and internal pharmacies, centered around the patient. Importantly, these entities have to work together, regardless of the application goal or its vendor. What’s at stake is the successful delivery of healthcare, on an individual, community, and national level.

What Are Some Ongoing Challenges for Interoperability?

More hurdles remain before EHRs can truly work together, including such difficulties as knowing which EHR contains a specific patient’s medical data and then securely providing access to that information prior to its use. Because of the significant value, ease of use, and potential effect, both patients and clinicians want, need, and are asking for greater access to shared information. In this stage in the interoperability process, even with many challenges lying ahead, the benefits of true interoperability are easily seen and promise to have a great impact (Howard, 2018).

What Are the Challenges for Revenue Cycle Management? Denials!

The Electronic Health Reporter shares that “More than three-quarters of the hospitals surveyed for a new HIMSS Analytics study said that denials are the biggest challenge they face with revenue cycle management.” One reason for that is likely linked to their use of multiple IT systems that don't work well together with the other myriad systems that are looking at numbers in different ways. This report was commissioned from HIMSS Analytics by Dimensional Insight, a developer of analytics and business intelligence technology. Of those having the most trouble with denials, 72.5 percent of respondents polled by HIMSS Analytics were using their electronic health record alongside three or more other revenue cycle management (RCM) systems to manage their revenue cycle. The report also found that one big hurdle for hospitals trying to make better use of analytics to automate revenue cycle processes might be the use of too many disparate systems for their revenue cycle. Indeed, 41 percent of hospitals said they used their EHR with two or more other vendors for RCM—some 16 percent are using two or more RCM vendors with no EMR. And more than one-third of respondents said that less than 25 percent of their revenue cycle process is automated with analytics. The upshot, according to HIMSS Analytics, was that, without full interoperability, data have to be normalized to drive improvements in the revenue cycle process. That can be a tall order (Miliard, 2018).

What this issue comes down to, as yet another risk in the healthcare revenue cycle, is that too many systems are being used while providing care to patients that fail to “talk to one another” well or don’t do so at all. Once organizations achieve a state closer to seamless integration, then we’ll see a reduced impact of denials due to billing errors and other data-based mistakes. In a world of low margins, where every penny earned in healthcare counts, this is something that needs to happen sooner rather than later. Likewise, if we are going to harness big data in the interest of improving patient outcomes, interoperability is key.

Learn more about HealthStream education solutions designed to help optimize Healthcare Revenue Cycle Management.

References

Howard, R., “Interoperability: The Promise of Healthcare,” ElectronicHealthReporter, Retrieved at http://electronichealthreporter.com/interoperability-the-promise-of-healthcare/

Miliard, M., “It's not just EHRs: Interoperability also poses big challenges for revenue cycle,” HealthcareITNews, May 7, 2018, Retrieved at http://www.healthcareitnews.com/news/its-not-just-ehrs-interoperability-also-poses-big-challenges-revenue-cycle

HIMSS, “What Is Interoperability?,” Retrieved at http://www.himss.org/library/interoperability-standards/what-is.

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