Healthcare organizations with best-in-class Interoperability have a competitive advantage because they can provide superior care, while streamlining member experience and reducing cost. With healthcare interoperability, MDM is a critical component of the overall interoperability requirements due to the management of many data sources with common types of data. The objective is to produce a single master record for each patient, provider claims transactions, and more.
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The healthcare domain has been undergoing a fundamental change in its approach to delivering care as Information and Communication Technology has become an indispensable component of healthcare. Providers and patients face rising costs, incessant ineffciencies, and healthcare quality failures. To address these issues, one must understand the critical role that interoperability plays in data sharing and re-use among disparate healthcare applications and devices.
When there are no enterprise data quality standards in place within an organization, consistency between data sources is nearly impossible. The major goal of standards in the healthcare domain is to improve patient care by allowing interoperability.
The healthcare domain is very complex because it involves many actors, such as doctors, radiologists, nurses, pharmacists, laboratory technicians. All must collaboratively participate in the treatment of patients.
Organizations must develop internal standards (or those mandated by CMS) before sending data to third-party vendors, payers, and CMS. Developing these internal standards can be challenging for organizations without a clear data governance strategy.
Different systems may have separate definitions of the same medical concept. This incompatibility makes interoperability diffcult. Outdated legacy systems make complete interoperability even more challenging.
Healthcare Networks are required by law to have a Master Provider Directory. If they do not, both Providers and Healthcare networks face the risk of being publicly reported by CMS for public information blocking. Fines and decreased patient enrollment could follow.
The Digital Contact Information policy requires all providers to list and maintain their information on the National Plan and Provider Enumeration System (NPPES). Providers will be reported if information is found to be outdated or incomplete.
Hospitals and Health Insurance Payers will have an increased demand for clean, standardized, enriched, validated, and centralized patient data.
Hospitals and Health Insurance Payers are starting to require more real-time or “near real-time” inbound and outbound feeds. Healthcare clients will have an increased demand for cloud integration tools and will eventually retire legacy on-prem ETL tools.
Policies, Processes, and Procedures centered around Data Entry and Data Management will need to be established for healthcare organization to meet compliance standards.
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