Complex Data Exchange and Healthcare

Healthcare organizations face continued challenges in improving quality of care, adopting new clinical and other technologies, lowering costs, and complying with regulatory requirements such as HIPAA. Often, these objectives require that organizations communicate and integrate across diverse internal and external systems for managing patient and service information. Examples include:

Consolidating Member Benefits Information
Managed care organizations need an integrated member view across multiple member benefit products that include medical, dental, behavioral health, pharmacy, flexible spending account (FSA), health savings account (HSA) and benefits spending cards. Benefits are often managed across multiple enterprise systems -- often as part of a complex COBOL legacy environment -- or may be outsourced to business partners. In managing member benefits, for example, to provide call center and web-based customer service, there is a need to expose and resolve member information across multiple data formats.
Consolidating Patient Information
Healthcare providers are moving from traditional reliance on paper-based records and isolated legacy systems (e.g., patient billing). With the evolution to electronic formats, many providers initially scanned paper records or used other ad-hoc document formats, but have now embraced more systematic electronic exchange of patient data. This data exchange occurs both within and across organizations such as other providers, diagnostic and laboratory test facilities, managed care organizations, etc. Creating and maintaining patient records requires the ability to extract and integrate patient data from a range of legacy document and system formats, as well as numerous internal and business partner implementations.
Leveraging Industry Standards
Many standards provide a common framework for information exchange, but often require additional programming effort to accommodate such factors as gaps, proprietary implementations, or multiple versions of standards, such as:
- Health Level 7 (HL7) was conceived as the common language for clinical data exchange and is used by more than 90 percent of healthcare facilities. With multiple versions of the standard in use (e.g., HL7 versions 2.1, 2.2, 2.3, 2.4, 2.5 and 3.0), there are extensive HL7 data format issues.
- Health Insurance Portability and Accountability Act (HIPAA) provides a framework to ensure government compliance while sharing information across provider and payer systems using a set of standard healthcare transactions. Real-world implementations require additional data translation and mapping to address variant implementations in HIPAA transactions and other key healthcare forms and transaction types, such as UB92 forms for hospital claims and NCPDP transactions for the pharmacy services sector.
Integrating New Clinical Technologies
Driven by improved and digitized clinical technologies such as imaging modalities, the need to further improve delivery efficiencies and lower costs, and a renewed focus on healthcare delivery quality, a range of technologies are finding more widespread adoption. Technologies such as digital imaging, PACS, speech recognition, and computer-based prescription order entry are driving a new set of integration needs to be part of effective enterprise-wide improvements.

Complex Data Exchange Solutions for Healthcare
Informatica's next-generation complex data exchange technology has been applied to a range of integration applications in the healthcare industry. Specific Complex Data Exchange solution capabilities that address the needs of healthcare include:

Support for transformation and mapping, via XML, of most healthcare industry standards including HIPAA, HL7, X 12, UB92 claim forms, and NCPDP transactions.
Pre-built frameworks for HL7 that enable co-existence of multiple versions of the standard (e.g., HL7 versions 2.1, 2.2, 2.3, 2.4, 2.5, 3.0, MLPP, ASTM and site-specific variations).
Support for a broad range of other data formats frequently encountered in business integration including unstructured data (e.g., document formats and print streams) and semi-structured data (e.g., advanced COBOL and proprietary implementations of standards). Click here for a full list of data formats supported.
Ability to embed Informatica data transformation for runtime execution in most distributed software infrastructure platforms including leading integration brokers, content and document management platforms, application adapters, and software applications built on J2EE, Microsoft .NET and native OS environments.

Key Technology Standards Support: