ZS was approached with a challenge—to help a healthcare plan achieve the data interoperability mandate set by the Centers for Medicare & Medicaid Services in only seven months. The mandate requirements are designed to give patients free access to their own medical information via mobile devices. Other healthcare plans had been moving in this direction for years but, due to a lack of resources and other challenges, this healthcare plan was unable to start sooner.
The pressure of a short timeline was exacerbated by lack of interoperability domain knowledge at ZS’s client. Further, incomplete and inconsistent data was scattered across four separate repositories. This fragmented architecture and lack of standardized data created significant complexity in the quest for interoperability, not the least of which was limited data definitions and schemas.
ZS swiftly assessed the current state of capabilities, identified gaps and remediation measures followed by vendor analysis to select the right enabling solutions. ZS then customized and deployed its own interoperability data mapping accelerator toolkit to map the client’s legacy data to the new format required by the CMS mandate, Fast Healthcare Interoperability Resources (FHIR).
To facilitate access to the client’s data via FHIR servers, ZS developed a data ingestion framework and architecture that supports real-time streaming, conversion and validation of multiformat and multisource data. This capability enables patients to access their own medical data securely whenever they want, however they want, using smartphones and tablets. Old-school batch processing isn’t up to the task.
ZS built and tested a prototype to prove the full interoperability and stability of the new platform, an exercise that revealed newfound strategic value for the client that extends well beyond meeting the compliance mandate.
All told, 3 billion data elements in four repositories were standardized and consolidated to achieve data interoperability compliance as well as some other features. The client’s new environment drives return on investment and creates opportunities to leverage artificial intelligence, population health management and value-based care, all of which are on the upswing across the healthcare ecosystem.
The end-to-end platform scales to support “multi-tenancy” that helps other health plans and third parties advance their own interoperability objectives and leverage cloud computing and automation to reduce administrative costs.
Throughout the project, the patient remained a central focus—the ultimate end user—as ZS mapped the journey to provide free, easy access to patient information ranging from lab results and prescriptions to medical claims and other personal data.
ZS established robust business processes to police error handling, audits, risk and security assessments while bolstering developer community engagement and consent management. The partnership extends well beyond the project’s completion date as ZS provides ongoing training, support and expertise to fortify the client’s data interoperability domain knowledge.
With ZS as its partner to navigate this journey, the healthcare plan not only achieved data interoperability compliance but also built robust new capabilities beyond the mandate’s requirements. The momentum to democratize data access is only increasing and the healthcare plan is now in a position to meet this challenge.