Tackling interoperability with EHRs and billing systems from different vendors

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Tackling interoperability with EHRs and billing systems from different vendors
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Although the topic and importance of interoperability has been discussed for years, according to new research from health IT and market-intelligence company Definitive Healthcare, about one in five hospitals report different vendors for their inpatient and ambulatory EHR systems.

This disconnect can lead to suboptimal patient experiences where critical information from a hospital stay may not make it in front of the primary care provider or outpatient results are not accessible by the inpatient team.

These are prevalent issues, ones even more relevant as a result of the covid-19 pandemic. With nearly one-third of hospitals reporting different vendors for their inpatient EHR and billing systems, according to the Definitive Healthcare data, missed procedures or miscoding can mean revenue losses.

Healthcare IT News interviewed Todd Bellemare, senior vice president of professional services at Definitive Healthcare, to learn more about today’s interoperability challenges and what hospitals and health systems can do to address them.

Q. Since about one in five hospitals report different vendors for their inpatient and ambulatory EHR systems, what does this mean for the healthcare provider organizations with different vendors, and how can it affect care?

A. It’s crucial for the integration between systems to be seamless, or the transfer of patient records can be compromised. This typically takes the form of patients dropping out of the system when a provider least expects it, or a patient can afford it.

For example, transferring a patient from the emergency room (ambulatory system) to be admitted (inpatient system) is a critical time for both the patient and care team, and an integration between two separate systems introduces additional moving parts that provide more opportunity for failure.

If patient records get stuck in transition between systems, there can be a lapse in critical care. These are core issues that have been prevalent for years, but have recently come to light even more as a result of the covid-19 pandemic.

Q. Your data also shows that nearly one-third of hospitals report different vendors for their inpatient EHR and billing systems. What does this mean for the healthcare provider organizations with different vendors?

A. Integrations between different vendors for inpatient EHR and billing systems can also introduce a myriad of potential issues. With nearly one-third of hospitals reporting different vendors for their inpatient EMR and billing systems, possibilities for missed procedures, visits or miscoding can result in potential revenue losses for the health system.

Different vendors bring about more moving parts, and if something goes wrong it could be detrimental to the hospital’s overall financial health. All too often we see hospitals and health systems hang onto their old billing provider because it’s been in place prior to the EHR and may have custom rules for management of codes and billing.

On the flip side, some facilities may want to cut costs, outsource billing departments and use the billing software the outsourced vendor uses. In either case, strong data integration processes must be followed to ensure medical claims are transferred quickly and efficiently, so that the billing department has ample time to clean and prepare claims for adjudication.

Q. What can hospitals with different vendors for inpatient and ambulatory EHRs do to resolve the issues created by this interoperability problem?

A. A variety of problems can arise from using different vendors for inpatient and ambulatory EHRs. Some of the most prevalent issues we see include HL7 interfaces or general flat file transfers. Problems like truncated files or a backup in the queue between systems are relatively common and will lead to missing patients or entirely absent patient panels for physicians and nurses.

Delays in care could result, which can cause trickle-down effects to other departments, reducing the efficiency of patient flow and treatment.

The majority of EHR vendors today offer some kind of API interface, which not only provides a more dynamic method of processing data, but is simpler to troubleshoot when things go wrong. This is essential for facilities to take advantage of.

The severity of missing patient data between systems in a clinical setting also requires a robust IT feedback loop that has created alerts when data is missing and can intervene at a moment’s notice.

Q. What can hospitals with different vendors for inpatient EHRs and billing systems do to resolve the issues created by this interoperability problem?

A. It all boils down to hiring the right people and communicating effectively when things go wrong. Healthcare facilities need to ensure that billing departments have employees who fully understand the back-end setup of the billing system and are knowledgeable about where and when they should expect data transfers.

Having a knowledgeable and well-trained staff onsite will curb issues and expedite solutions if and when problems arise.

Additionally, the team needs to properly communicate and have a cross-functional relationship with the IS/IT team. If data is ever missing or compromised, the billing team needs to have the proper steps in place to alert the IS/IT team or help troubleshoot to ensure claims are processed and submitted on time.

Twitter: @SiwickiHealthIT


Email the writer: [email protected]


Healthcare IT News is a HIMSS Media publication.

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