FHIR (pronounced “fire”), which stands for FAST Healthcare Interoperability Resources, is a standard protocol for exchanging electronic health data throughout the healthcare ecosystem, irrespective of the technology used.

According to research, the average health system has over 18 distinct EMR vendors in use. Healthcare data is siloed, making it hard to get a complete view of a patient across the care continuum. In order to manage, discover, and share data quickly and easily across specialties and locations, we need a way to make electronic health data interoperable.

FHIR, which is free to use and vendor neutral, allows developers to build web-based applications that enable users, in essence, to access data from different health information platforms on a browser page. The FHIR Applications Programming Interface (API) standards support both iOS and Android devices and are quickly becoming the foundation for making health data fully interoperable.

Health Information Management is the process of gathering, analyzing, and interpreting health data and maintaining its privacy and security.

HIM plays an essential role in ensuring the accuracy of health information and the quality of healthcare that providers can deliver. It not only ensures that patients are appropriately treated across the care continuum. It also ensures that providers and payers receive the reimbursements they deserve.

While the primary role of an HIM department has been on managing information, changes in payment models require that HIM professionals are involved with additional functions, including quality care  improvement, revenue cycle management, and financial planning. As the majority of health data becomes electronic, HIM professionals will spend more time monitoring and auditing information and serving as patient advocates, helping patients get access to their own data.

Hierarchical Condition Category coding — or HCC coding — was implemented by the Centers for Medicare and Medicaid Services (CMS) in 2004 to help estimate the healthcare costs of Medicare enrollees in the coming year.

HCCs are based on the International Classification of Diseases (ICD-10-CM) codes and supplied to health plans and Medicare by healthcare providers. ICD-10 codes document patients’ diagnoses. There are over 10,000 ICD-10 codes that reflect the specificity of each medical condition.

Medicare Advantage plans, the Medicare Shared Savings Program, Medicaid, and private health plans use the CMS-HCC risk adjustment model to determine the health mix of their member enrollment. Accurate and timely coding is critical to ensuring they receive reimbursements from CMS that reflect the services rendered to their members.

CMS continues to add HCCs annually to capture patient diagnoses and treatments with more specificity. COVID-19 has resulted in fewer opportunities to capture HCCs due to a decrease in patient visits, putting more demand on risk adjustment to discover and fill coding gaps. However, if the use of telehealth, approved temporarily during the pandemic, becomes permanent, health plans may capture additional opportunities to improve risk adjustment factor (RAF) scores.

Release of Information (ROI) in healthcare refers to the process of providing access to protected, confidential health information to an individual or entity authorized to receive it. In order to protect patients’ confidentiality, state and federal regulations govern how, when, what, and to whom protected health information is released.

When an efficient ROI process is in place, time-sensitive health information can be exchanged quickly and safely to ensure patients’ continuity of care. Additionally, it can help reveal insights that transform the quality and cost of healthcare. Working with a company that has a successful ROI process in place can improve relationships with medical staff by reducing the burden on to address high volume requests and seasonal spikes.

Automation technology will improve the efficiency and safety of health data exchange between individuals and entities. It facilitates real-time reaction to data, enhancing quality of care and reducing burnout for medical staff.

Real-world data (RWD) is observational data. Unlike data derived from randomized controlled trials (RTCs), RWD includes the data in EHRs, medical claims, registries, patient-generated data, mobile devices, and other sources. It includes the effects of a treatment or medical device that may not have been discovered in a RTC. To learn more read our blog, What is Real-World Data.

Clinical trials do not track the entire population of patients with a particular disease or condition. RWD can provide a more comprehensive view of patients’ reactions to a treatment or the use of a medical device after its approval. It has the potential to give healthcare systems the evidence they need to improve patient care and efficiencies and reduce inappropriate or unnecessary treatments and costs.

As real-world data becomes more accurate and complete, it can maximize providers’ ability to prescribe the right treatments to the right patients at the right time.

Real world evidence (RWE) is clinical evidence captured during the course of a physician, clinic or hospital visit. Unlike data derived from randomized controlled trials (RTCs), RWE is observational data that includes the effects of a treatment or medical device that may not have been discovered in a RTC.

Clinical trials do not track the entire population of patients with a particular disease or condition. RWE analyzes data stored in EHRs, medical claims, registries, patient-generated date, mobile devices, and other sources to provide a more comprehensive view of patients’ reactions to a treatment or the use of a medical device. It has the potential to give healthcare systems the evidence they need to improve patient care and efficiencies and reduce inappropriate or unnecessary treatments and costs.

RWE depends on the accuracy of available real world data. As that data becomes more accurate and complete, RWE will maximize the ability to provide the right treatments to the right patients at the right time.

Record retrieval is the process of securing complete and accurate medical records and clinical documentation from physicians, hospitals and other healthcare professionals. Health plans, attorneys, government agencies, and life insurance companies all need accurate data to conduct their businesses.

Good record retrieval requires the ability to locate, review, and retrieve records quickly, reliably, and securely. A medical retrieval company with existing relationships with a broad network of providers and an automated process to secure records can turn a complex, often unmanageable process into one that runs like clockwork. It can also minimize disruption to medical staff and ensure continued compliance.

Automation will maximize record retrieval yield and improve the workflows for providers and recipients alike. Technology that has the capability to manage both structured and unstructured data and handle records from a full range of disparate EHR platforms will improve the quality of information and the speed at which it can be accessed.