We tend to think that our insurer already knows information about us, but their systems have been tuned more toward accepting and paying claims — often without the details on exactly what was done from a medical standpoint. In fact, most people have never seen their complete health record, and neither can their doctor.
Creating an ecosystem where Health Information Exchanges (HIE) can function without the reliance of direct point-to-point relationships is a focal point of healthcare IT strategy and planning. “There has been a great deal of progress, but the majority of healthcare entities are still concerned about controlling access to health information systems, applications and patient data,” explains Seonho Kim, Chief Architect at ApeniMED which specializes in enabling HIEs. “They require a stronger, standards-based, interoperable, and easy-to-use security infrastructure — especially federated identity and security and privacy controls. The result is that a lot of healthcare entities and systems still remain as silos.
“The lack of standardized strong identity would be the biggest obstacle in the success of health information exchanges and progressing toward next stages,” he adds. This has created a huge gap in operational efficiency, cost and quality of care.
Defining the Stakeholders
There are obvious non-technical challenges that each primary stakeholder group faces in the healthcare environment:
• Patients need to know they can receive and afford the best-quality care and it will be paid for, in most cases, by their insurance provider;
• Healthcare providers must be assured that the insurance companies will pay them, that they have the ability to perform the best in timely care at the lowest possible cost, with the ability to track fraud and abuse of the system; and
• Insurance providers and the government (Medicare/Medicaid) need insight into eligibility, outcomes vs. cost, and the ability to detect and track fraud before offering payment.