Electronic Health Records (EHRs) have become the central resource for provider workflows, facilitating administrative and clinical activities. In fact, according to The Office of the National Coordinator for Health Information Technology (ONC), as of 2021, 78% of office-based physicians and 96% of non-federal acute care hospitals adopted a certified EHR. EHRs integrate data from diverse health IT systems, including practice management systems (PMS), state registries, pharmacy systems, and health plan systems. When these external systems are integrated with the EHR, providers are empowered to make informed clinical decisions based on a complete, up-to-date patient health record, and can streamline the associated administrative and revenue cycle tasks of patient care. Integrating EHRs across the healthcare ecosystem is essential in enhancing delivery, coordination, and efficiency of healthcare services, ultimately leading to improved patient outcomes, reduced errors, cost savings, and the ability to make data-driven decisions. A lack of data standardization and interoperability across these platforms poses a significant challenge for providers, contributing to increased cost and time burdens that arise from the need to support manual workflows that align and integrate disparate data sources.
In 2022, CAQH CORE conducted an industry environmental scan to understand challenges and opportunities to streamline EHR integrations. Industry feedback collected from provider organizations, vendors, and a health plan determined that addressing issues related to data uniformity would promote system alignment, reducing provider burden and speeding the revenue cycle process. Variability of data formats and the display of key data elements work against automation and prevent providers from quickly digesting information. These inefficiencies become most apparent for workflows supporting prior authorization, eligibility and benefit verification, and the exchange of attachments.
Research identified the following areas, that if addressed, could facilitate data standardization and promote streamlined integration of EHRs with other systems.
During the CAQH CORE environmental scan, interviewees also indicated that issues surrounding connectivity limit data integration between EHRs and external health IT systems; particularly those employed by health plans. For instance, providers expressed that single sign-on authentication would enhance workflows by allowing EHR credentials to simultaneously fulfill health plan portal workflows. Additionally, integration with state registry and laboratory systems is complex, and requires multiple proprietary connections to facilitate reporting. This leads to costly one-off infrastructure investments and can contribute to missing or errant patient data if connections are not correctly established. There is a need for bi-directional interfaces with state and laboratory systems that ensure the uniform, quick, and secure exchange of patient data that informs care and fulfills mandated reporting requirements. Industry alignment to frameworks established by the CAQH CORE Connectivity Rules supports common, scalable, and secure transmission of data across a multitude of systems.
Stakeholders also acknowledged challenges that accompany an evolving healthcare industry. The rise of convenient telehealth appointments, popularized at the start of the COVID-19 pandemic, has made it difficult for providers to access patient records, document conversations and bill for visits in a singular, integrated environment. Despite the widespread adoption of telehealth platforms, stakeholders reported their integration with EHRs remains inadequate, forcing healthcare providers to manage multiple devices and software during virtual visits. The integration of a telehealth platform with an EHR can simplify the process by providing providers with easy access to visit information and real-time clinical documentation on a single device at the point of care. To facilitate the integration of telehealth into EHR systems, providers must overcome the significant challenge posed by the high cost of infrastructure investments. Necessary integration could be supported by incentive programs, sponsored by either the federal government or private insurers, that help defray the significant financial and time investments to merge telehealth solutions into EHR platforms.
Industry initiatives and public policies are already underway to enhance automation, interoperability and integration between EHRs and other systems, utilizing API-based approaches and emerging standards such as HL7 FHIR. To support EHR integration efforts, CAQH CORE has taken several steps to improve provider to health plan interactions through workflow automation and data standardization efforts. These include publishing the CAQH CORE Connectivity Rules, CAQH CORE Eligibility & Benefits Operating Rules, CAQH Prior Authorization & Referrals Operating Rules, and CAQH CORE Attachment Operating Rules to support revenue cycle workflows and educating the industry on the benefits of operating rule implementation. Additionally, CAQH CORE is convening Health Care Claims, Value Based Payment, and Eligibility & Benefit Subgroups in 2023 to assess opportunities for advancing EHR integration initiatives, such as telehealth and data reconciliation. These current initiatives seek to address some of the challenges discussed in this post by continuing to streamline the revenue cycle and promote interoperability between systems.
CAQH CORE continues to work collaboratively with diverse stakeholders to identify gaps in healthcare automation and develop solutions to ensure administrative efficiency. To get involved, please reach out to core@caqh.org.