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HL7 FHIR Helps Bridge the Gap Between Cleveland Clinic and Payer in Collaboration

[fa icon="calendar"] Jul 7, 2020 5:27:01 PM / by Fred Bazzoli

‏Virtual DevDays session report

Report from Virtual FHIR DevDays 2020

The Cleveland Clinic and Oscar Health announced a partnership in mid-2017 that was going to require a level of provider-payer integration that the organization hadn’t attempted before.

More challenging still was the fact that the timeline was short – some of the capabilities that would enable improved patient interactions had to be in place by January 2018. The use of the HL7 Fast Healthcare Interoperability Resources (FHIR®) standard addressed many of the technical challenges in hitting those deadlines.

Integration between the entities still was difficult to achieve, noted Matthew Coolidge, who was then the IT product director at the Cleveland Clinic and is now CEO of Orbital Health. When he was in his Cleveland Clinic role, he was the organization’s subject matter expert on FHIR. Coolidge shared lessons learned in the initiative in a keynote presentation at the recent HL7 FHIR DevDays virtual meeting.

The goal was for the healthcare organization to sync demographics and insurance information with Oscar Health, which provides concierge service for members that it insures. That put a premium on matching patient identities across the two organizations’ information platforms.

Actual integration between the entities didn’t begin until September 2017. In addition to matching existing records in the systems, coordination also involved managing updates between the systems as patient/member information changed over time. The goal was to give patients a seamless, simple experience with no double entry of information.

Enabling patient self-scheduling – a key initiative negotiated in the collaboration – took longer to achieve and faced more challenges. For the technical solution, FHIR was used to help query providers’ schedules so patients could see potential appointment slots and reserve an appointment. Some of the technology proved challenging because scheduling management functionality previously had been maintained within Cleveland Clinic’s electronic medical record system.

Beyond the technology, the organization faced pushback from provider offices. Coolidge noted that scheduling is harder than it looks because some feel patients shouldn’t have this ability and there were doctors who canceled appointments because they hadn’t spoken with the patients on the phone first. He also pointed out that while they were able to solve the technology challenges, the cultural and operational changes were more difficult to overcome. He stressed that both workflow expectations and providers’ workflows need to be addressed to improve access to care. Finally, Coolidge emphasized that organizations shouldn’t underestimate the hurdles they will face – changes that some thought were minor wound up having a ripple effect.

Missed Virtual FHIR DevDays?

If you were unable to attend the virtual edition of FHIR DevDays, you can purchase the recorded version at the HL7 On Demand site.

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Topics: FHIR, HL7 community, interoperability, health IT, Payers, scheduling

Fred Bazzoli

Written by Fred Bazzoli

Fred Bazzoli is a writer specializing in healthcare IT topics. He's a former editor for several healthcare IT publications and past communications director for both CHIME and HIMSS.

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