Case Study
How UST enhances patient access interoperability with FHIR-based APIs
OUR CLIENT
This American multinational company provides data and technology services, such as analytics, predictive insights and fraud prevention, to reduce risks and improve decisions for government entities and businesses across various industries. With offices around the world, the company employs approximately 10,000 people and serves clients in more than 150 countries.
THE CHALLENGE
Retrieving healthcare data from multiple payers amid single endpoint federal mandates
Aiming to capitalize on federal mandates for health information interoperability, the data analytics company sought to facilitate seamless, automated access to “patient access” data regulations through standardized APIs (application programming interfaces) that must be published by healthcare insurance companies (payers). The solution needed to allow customers to retrieve data from a single endpoint using a unified API, ensuring compliance with patient access data regulations that mandate member consent for each endpoint. The multi-payer healthcare data integration efforts targeted the largest 25 payers in the United States, encompassing Medicare Advantage, Medicaid, CHIP and federal ACA data integration offerings.
THE TRANSFORMATION
FHIR-based API integration for compliant healthcare data patient access
UST designed and developed a healthcare data access SaaS (software-as-a-service) patient engagement platform to enhance healthcare data interoperability and patient access. The platform includes the following key features and capabilities:
- Authentication of end users: Securely verifying users accessing the platform via API ensures data privacy and compliance.
- Payer selection: Empowering users to seamlessly choose payers through their application, which streamlines the data retrieval process.
- Single API request: Users are able to efficiently request patient data from multiple payers through a unified API.
- Endpoint management: Maintaining and updating payers’ endpoints and metadata ensures continuous system optimization and reliability.
- Data output: Utilizing fast healthcare interoperability resources (FHIR) to standardize data exchange promotes interoperability across healthcare systems.
THE IMPACT
Advancing healthcare data interoperability
The development of the API-driven patient engagement platform resulted in substantial advancements for the company’s healthcare data interoperability and patient access initiatives, including:
- FHIR resource retrieval: The platform can call various payers and retrieve FHIR resources, enhancing data accessibility.
- Data storage and retrieval: The solution offers seamless storage and access of payer details, ensuring efficient data management.
- Data cleansing: It cleanses FHIR resources (e.g., name, address, telecom, email) to meet company data standards, ensuring data accuracy.
- Integration with internal company data sources: Enriching information with additional details (e.g., patient keep contact and socio details), users can gain comprehensive insights to make more informed decisions.
- New auditing and billing platform: The solution facilitates auditing for each request and response, with billing capabilities based on usage, ensuring accountability and proper resource management.
- Developer portal for healthcare data access: It features comprehensive patient access API documentation, examples, and testing tools, facilitating seamless integration and development for end users.
- Admin portal enhancements: The solution provides effortless configuration and management of instructions for 25 supported payers, ensuring operational scalability and adaptability.
At UST, we leverage innovative technologies and intelligent automation to enhance healthcare data exchange processes and improve patient outcomes while ensuring compliance with federal and industry mandates. To learn more, access our patient experience whitepaper here.
RESOURCES
https://www.ust.com/en/industries/healthcare/interoperability/compliance-modernization
https://www.ust.com/en/industries/healthcare/interoperability
https://www.ust.com/en/insights/accelerating-healthcare-interoperability