Interoperability - a platform to enable 21st century care
“Imagine this situation: you go to a supermarket and before you pick up anything from the shelf, the manager needs to call your bank to find out if you are eligible to buy it. Then when you reach the checkout counter, your bank has to confirm if they will allow the charge on the credit card or if you need to pay cash for a particular item and ask the supermarket to raise a invoice to them against your purchase! Imagine the number of people who would be involved in calling up the bank, responding to the questions at the bank and working on preparing the paperwork for the invoice and then adjusting it against their system. Now that you have visualized it, try to also imagine the costs involved around the same and how much you are paying for that box cereals actually went into making that box and bringing it to you at the store.
But to all of us who go to a doctor’s office or to any other provider in the US, this is a reality. If we are able to convert a much higher volume retail operation to a near real time scenario, what prevents us from doing the same to a much smaller volume medical transactions? The answer lies in the following:
- Lack of interoperability across the various stakeholders and missing/disparate standards
- Complex, legacy systems that cannot realistically support real time transactions
- Poor adaption of electronic records with providers
- No incentives for the providers and the payers to make this happen
If we are able to address this issue it will help us to address 3 key problems that we all complain about
1. A higher percentage of the dollars the member use for HC can actually go to care rather than support administrative work. This will undoubtedly improve the efficiency
2. A significant reduction in “siloed” information will help create better care for members
3. Real time comparison on cost of care would ensure fair charge and also help people with newer plans like CDHP etc
So how do we go about doing this? A centralized information repository with patient information, seems to be the most logical starting point. There are key performance, access and HIPAA related concerns that we need to address, but those are technical nuts and bolts that can be build in once we have an agreement to go forward at the industry level. The second aspect would to create and support a B2B exchange where providers, payers and clearinghouses can seamlessly connect to one another. The third component of this solution would involve the member – a B2C and a C2C peer exchange with robust analytics should ensure that the information captured is put to good and probably to meaningful use – and not just as another input to underwriting. The web 2.0 technical components and tools can help create these platforms.”
