Understanding clinical data exchange and cda (hl7 201)
-
Upload
edifecs-inc -
Category
Healthcare
-
view
252 -
download
3
Transcript of Understanding clinical data exchange and cda (hl7 201)
Understanding Clinical Data Exchange and HL7 CDAfor Claim and Prior Authorization Attachments
1. Overview: Why HL7 was created
2. Benefits: How Health Plans can utilize HL7 today. Use Cases
3. CDA: Understanding the building blocks
4. CDA and IGs: Understanding different IGs
5. C-CDA and Attachments:
How C-CDA are used with Attachments
6. Resources:A list of supporting
websites for more info.
Agenda
Speakers
Julia Sakhnov, Product Manager, Trading Solutions
Pathways to Partnerships | Bridging Connections For ValuePathways to Partnerships | Premier Partnership Solutions for Healthcare
Industry Initiatives
Paper to Electronic Records
Meaningful Use standards
Public Health
National-Regional IT Networks
Personalized Medicine
Driving standardization of information exchange
PopulationHealth
PaymentReform
On top of simple needs for doctors to
Be connected and be able to efficiently
exchange information, there is a lot of
external factors driving standardization
of information exchange from market to
various government initiatives:
The cost of providing healthcare is constantly rising
Move from paper to electronic records
Meaningful use standards Public health reporting Consumer empowerment National-regional IT networks Personalized medicine
And as the industry moves toward a
population health model, there is more
need for wider applicability ofstandards.
Pathways to Partnerships | Bridging Connections For ValuePathways to Partnerships | Premier Partnership Solutions for Healthcare
Collaboration Move toward value-based models requires more collaboration and integration of all data-sets (Clinical, Admin and Financial) to drive down healthcare costs.
PAYER ENTERPRISE
PROVIDERENTERPRISE
Encounter Data
x12 5010 (ICD10)
Quality-Based Incentives
HL7 v2.5 (CCD)
Patient Data Pop Risk
Pathways to Partnerships | Bridging Connections For ValuePathways to Partnerships | Premier Partnership Solutions for Healthcare
Payer HL7 Use Cases
EnrollmentHealth plans design the process of on-boarding of new members.
Utilization ManagementHealth plans design care pathways using evidence-based medicine to focus on the right amount of patient care – not more or less than required.
ReimbursementAll providers submit claims to a health insurance organization to be reimbursed for care provided.
Care ManagementA small number of individuals will incur the most serious health problems and a disproportionately large percentage of total healthcare expenses.
Care management seeks to identify individuals with these conditions and dedicate resources to managing their care.
Disease ManagementDisease management focuses on patient populations who already have or are at risk for a specific chronic illness or medical condition.
Unlike care coordination, the members within the identified population do not receive customized care. Rather, one plan or campaign is implemented in the same way for all members of the identified population.
Pathways to Partnerships | Bridging Connections For ValuePathways to Partnerships | Premier Partnership Solutions for Healthcare
Why Electronic Attachments
Medicare FFS Improper Payment for FY 2014
Service Type Improper Payment Rate
Improper Payment Amount
Inpatient Hospitals 9.20% $10.4B
Durable Medical Equipment 53.10% $5.1B
Physician/Lab/Ambulance 12.10% $11.0B
Non-Inpatient Hospital Facilities 13.10% $19.2B
Overall 12.70% $45.8B
?
Pathways to Partnerships | Bridging Connections For ValuePathways to Partnerships | Premier Partnership Solutions for Healthcare
Why Electronic Attachments
2014 CAQH Index: Electronic Administrative Transaction Adoption and Savings (2013)
Claim Attachments: plans for 103 millions enrollees
1 claim attachment for every 24 claims
health plan cost - about $0.63 per transaction
provider cost – about $5 per transaction
Prior Authorization Attachments: plans for 49 millions enrollees
1 attachment for every 11 prior authorizations
provider cost – about $45 per transaction
http://www.caqh.org/sites/default/files/explorations/index/report/2014Index.pdf
Pathways to Partnerships | Bridging Connections For ValuePathways to Partnerships | Premier Partnership Solutions for Healthcare
Electronic Attachmentsfor P&C
P&C: Jopari Solutions - 5 Year Case Study
Pathways to Partnerships | Bridging Connections For ValuePathways to Partnerships | Premier Partnership Solutions for Healthcare
Electronic Attachments
2005 Health Care Claims Attachments NPRM :ANSI X12N 275 version 4050
HL7 CDA R1 – Additional Information Specification (AIS) Booklethttp://www.gpo.gov/fdsys/pkg/FR-2005-09-23/pdf/05-18927.pdf
Expectations:ANSI X12N 275 version 6020
HL7 C-CDA R2 and CDP1
Pathways to Partnerships | Bridging Connections For ValuePathways to Partnerships | Premier Partnership Solutions for Healthcare
Covered Further
Deep Dive into Clinical Data Architecture
Demo of patient use CDA Samples: Operative Notes Header nonXML Body Structure Body Constraint
Levels and LOINC Codes Schematron Rules with
Example CDA Implementation Guide
And More……
Also learn aboutCDA In relation with C-CDA,CCD,CDP1
Demo of Payer and Provider Use cases
Useful Resources
And More……
Pathways to Partnerships | Bridging Connections For ValuePathways to Partnerships | Premier Partnership Solutions for Healthcare
Question andAnswers
Edifecs http://www.edifecs.com/downloads/Clinical_Health_Level_7_Brief_2014.pdf
HL7 http://www.hl7.org/
CDA and Implementation Guides
http://www.hl7.org/implement/standards/product_brief.cfm?product_id=7
HL7 Payer User Group http://www.hl7.org/Special/committees/pug/
Resources
Pathways to Partnerships | Bridging Connections For ValuePathways to Partnerships | Premier Partnership Solutions for Healthcare
Next Steps
Coming SoonContactShare
Look for invitations to our next HL7 Educational webinar
Access recorded webinar Questions/more information contact: [email protected] or call 425-452-0620