Integrating claims systems with practice management and electronic medical record systems has been floated around the industry for a few years.
The HITECH piece of the American Recovery and Reinvestment Act, however, may push the players toward that goal.
While considering such integration a “pipe dream,” Carl Doty, vice president and research director at Forrester Research, noted that getting the majority of physicians on a structured EMR and getting clinical connectivity between provider organizations must be achieved first.
Those efforts are happening today. Aggregating data is one of the steps down the path to integration, said Ned Moore, CEO and co-founder of Portico Systems.
Payer- and provider-sponsored patient-centered medical home pilot programs are marrying claims and clinical data, he said. Health information exchanges, which will also benefit from the HITECH Act, are in a position to provide data connectivity, he said.
Once standards are in place, integration and data exchange will be easier to do. In the meantime, it’s critical for IT companies to provide a translation layer that will make data consumable to all users, he said.
EDS is focused on integrating data at the point of service, said Mark Roman, vice president of EDS’ Global Healthcare Industry. “Integrating into the physician’s workflow is an absolute must,” he said. Data integration in the workflow provides more efficiency than systems integration, which requires physicians and their staff to handle myriad business processes. The goal is for all stakeholders to communicate and use data.
The TriZetto Group provides core administration systems for payers as well as a hosted provider system. “There’s a business reason to connect claims data to the provider,” said Dan Spirek, executive vice president. “This is a long-time strategy of TriZetto’s to push out claims data and other patient data to the provider.”
According to a TriZetto Group survey, 75 percent of ambulatory providers want integration in a cross-care setting. Getting claims data into the physician workflow, whether it be manual or electronic, is ultimately more critical than systems integration, Spirek said. He said he hoped that the federal stimulus funds can be spent where it makes a difference – go to where valuable data is and share that data across settings.
