What are the advantages of electronic data interchange EDI for the physician the patient and the medical office staff?
|
Posted on April 20, 2021December 12, 2021 Show
Anyone who has sought medical care for any purpose knows that scads of paperwork are generated with every case. Not only does every medical visit involve stacks of forms full of fine-print paragraphs that are nearly impossible to read, but billing systems generate even more paper waste. Those forms and documents pass through many hands, exposing patients’ private information and increasing the risk of human error. Healthcare Electronic Data Interchange (EDI) technology ensures the security and privacy of electronic data transmission. It significantly reduces healthcare paperwork and the filing and storage nightmare that goes with it. Healthcare EDI also protects patient privacy and allows patients to retrieve and review their own medical records. Equipping your clinic or practice with EDI software will dramatically improve your workflow, enrich the quality of care you are able to provide your patients, and increase patient loyalty. In this article, we’ll talk about EDI technology as such, its basics, transactions, legal background, and popular types of EDI software, including common EDI tech applications in medical facilities and computer-aided systems across the US. Moreover, you’ll understand how EDI works, and what aspects are to be taken into account when you build a new EDI-equipped system, and whether it’s possible to add EDI to your current healthcare software system.
Healthcare EDI and HIPAA ComplianceConcerns about healthcare security and privacy are nothing new. In fact, they were addressed with legislation, long before the public worried about hackers and Internet data breaches. In 1991, the Workgroup for Electronic Data Interchange was created under President George H. W. Bush. The NPO was tasked with reducing healthcare costs in the United States. In 1996, as the electronic transmission of healthcare information increased, the group played a pivotal role in the enactment of the Healthcare Insurance Portability and Accountability Act (HIPAA). HIPAA’s primary objective was to institute national standards to protect patients from an invasion of privacy, a right guaranteed by the US Constitution’s 4th Amendment. HIPAA safeguards patients’ sensitive health data from being shared without the consent or knowledge of the patient. The HIPAA system assigns identifiers to professionals who have access to private health information, including insurance providers, clinicians, administrators, and anyone else privy to personal health details. The identifiers ensure that patient records are viewed only by individuals who have been authorized by the patient and are accessing their records under the protection of special electronic data interchange tools, preventing privacy leaks. HIPAA includes an EDI Rule that obliges all healthcare-related entities in the US to enter their electronic data transmissions in compliance with a common EDI tech format. The “EDI rule” sets ANSI ASC X12 (X12) as the transmission protocol standard, providing a list of specific tech requirements that must be implemented by all covered organizations in their daily data operations. If a healthcare provider or any other entity accessing medical records knowingly violates the EDI rules for HIPAA compliance, they risk having to pay considerable penalties, depending on the degree of negligence and the type of HIPAA violation. Fines can be as high as $10,000-50,000 USD per violation. In some cases, a criminal investigation and prosecution are even possible. The HHS Office for Civil rights is charged with enforcing EDI compliance in the healthcare industry. Healthcare Electronic Data Interchange enhances compliance with HIPAA guidelines by streamlining the handling of medical records and other sensitive documents. It reduces the exposure of private patient records to unauthorized entities while increasing the speed, accuracy, and efficiency of record-keeping. HIPAA EDI software solutions are both advantageous and required by law in the US.  What is Healthcare EDI?People everywhere have grown accustomed to having instantaneous access to data, especially when it comes to personal records. With today’s technology, there is no excuse for keeping them waiting. Yet the healthcare sector has lagged behind in adopting technology to organize, store and administer patient records. HIPAA-regulated EDI transactions ensure that standardized medical documents are accessible and manageable via certified software systems. In addition to establishing standards for protecting patient privacy, HIPAA acknowledges the legally enforceable right of patients to request and gain access to their own healthcare records. For most of us, that means immediate access, without having to wait for days or weeks. EDI transactions replace traditional paper documents and unprotected computer-generated text emails, PDF files, fax, USB drives, and other vulnerable documents. Paper-based transactions are slow and can never guarantee instant access, and computer communications may expose your sensitive records to the risks of data breaches, tampering, or loss. Along with establishing a common structured format for sensitive data, EDI allows for the unified and consistent transmission of medical records across a multitude of data systems used by various healthcare-related entities and patients across the USA. Prior to the acceptance of EDI standards in 1996, there were 400+ electronic formats in use for transmitting healthcare claims, resulting in poor interoperability of different systems and higher costs of IT services due to persistent data conversion errors. To meet HIPAA standards for access and privacy, insurers and healthcare providers are turning to EDI solutions for secure and private electronic transmission of patient records. HIPAA-regulated EDI transactions also make it easier for medical professionals to share vital patient information, to prevent misdiagnosis, incompatible medications, ineffective treatments, and other vital errors that endanger patient health. How Does EDI in Healthcare Work?The medical EDI X12 standard works as a bridge language between the computer systems of different US healthcare organizations, allowing for smooth automatic communications among them. Additionally, HIPAA EDI technology creates a layer of protection for data transmissions between different electronic systems and healthcare applications to keep patient data confidential. Thanks to secure healthcare EDI transactions:
The EDI-Standardized Transaction ProcessThe X12 EDI ANSI standard is generated by X12, a non-profit organization that develops cross-industry standards accredited by the American National Standards Institute (ANSI). The standards are widely used to build EDI systems in the USA. The EDI transaction process for healthcare and other EDI supported industries follows a series of steps: Step 1: Prepare data to be transmitted Create a document or a file with a correctly organized data structure. This can be accomplished in several ways:
Step 2: Format the document to match EDI X12 requirements Electronic data must be translated into the EDI standard message format featuring specific data segments and elements. Typical EDI files in healthcare consist of segment names, segment/element separators, data elements, composite elements (data groups), and some other essential syntax units. This task can be carried out with the help of software supporting HIPAA EDI formats or done manually by a programmer. Step 3: Transmit your EDI-formatted healthcare document to an authorized receiver Once the documents have undergone EDI formatting, it’s time to establish a connection and send them to your EDI trading partner using one of several available EDI communication channels:
Modern EDI-compliant software products allow authorized users to seamlessly execute business operations in a few clicks. Other EDI StandardsThe X12 standard is not the only EDI standard available. The UN-backed Electronic Data Interchange for Administration, Commerce, and Transport (EDIFACT) protocol is an alternative to X12 and is recognized internationally, used predominantly outside of North America. EDIFACT was developed under UN supervision and is widely used in Europe and Asia for a variety of business applications. However, only the EDI X12 standard works for HIPAA-compliant documents. EDIFACT is not compatible with HIPAA requirements. Types of healthcare EDI transactions include:
Advantages of implementation EDI in HealthcareHealthcare EDI transaction software is transforming the healthcare business by reducing tedious paperwork and costs, enabling healthcare providers to spend less time and money on administration, and more time focusing on patient health. Benefits of implementation EDI in healthcare include:
EDI solutions put everyone on the same page, so that healthcare providers are able to prioritize patient care. At the same time, patients are able to access EDI records and co-manage their healthcare needs. Custom EDI software is a
win-win solution for everyone, bringing today’s healthcare systems up to speed to meet the demands of the 21st Century. Development Guidelines for EDI Healthcare SoftwareHealthcare software development must take into account EDI standards for HIPAA compliance. In addition to safeguarding sensitive information about patient health, EDI transactions are used for:
With so many moving parts for each patient visit and treatment, it makes sense to adopt a software system that can manage all aspects of the patient journey, from their first encounter with the system through their final payments and beyond. Types of EDI Software: What EDI Solutions Are Popular With Healthcare Providers?There are numerous different software solutions that use EDI-standardized transaction sets. The most common EDI software systems include:
Components of HIPAA Compliant EDI Healthcare SoftwareCustom EDI solutions have four essential EDI system components:
Developing HIPAA compliant custom medical software with EDI technologyNot all available healthcare software systems meet the highest HIPAA standards, and using them can lead to Protected Health Information (PHI) violations, making users liable and subjecting them to damages and penalties. Sometimes, legacy software systems do not support the latest version of EDI standards. Those medical systems can be upgraded and integrated with EDI-supporting modules. Whether you’re developing custom healthcare EDI software or implementing EDI into existing systems, it’s important to adhere to certain requirements for secure operations of PHI:
Customized EDI Software Solutions from TATEEDAChoosing or building a healthcare EDI software solution capable of covering all the needs and requirements of modern healthcare requires expertise in HIPAA EDI standards and knowledge of medical software architecture. TATEEDA is a reliable partner that can help you build a HIPAA compliant custom healthcare EDI software system. We can also implement EDI support for your existing software system, or consider re-engineering other types of legacy systems. We are experts in conceptualizing and developing full-cycle/full-stack medical software systems that support EDI communications, such as:
Other services provided by TATEEDA include project-based staff augmentation, outstaffing services, and on-demand legacy software modernization. Do you have a software solution idea for your healthcare facility or organization? Please get in touch with us for a free consultation! Why Build Custom EDI Healthtech Solutions with TATEEDA?Whether you are a small private practice or clinic, or a large healthcare system that serves thousands of patients, TATEEDA can design and develop a custom EDI software solution to meet your unique needs. TATEEDA’s EDI software is safe, secure and HIPAA compliant, to protect you and your patients from data privacy breaches. Reduce costs and paperwork, increase accuracy and efficiency, and bring your organization up to speed to meet today’s demands for access, privacy, speed, and compliance in healthcare management. Contact TATEEDA today for a consultation and free estimate! What are the benefits of electronic data interchange EDI )?Benefits of EDI. Lower operating costs.. Improve business cycle speeds.. Reduce human error and improve record accuracy.. Increase business efficiency.. Enhance transaction security.. Paperless and environmentally friendly.. Perceived high upfront costs.. Initial setup is time consuming.. What is Electronic Data Interchange EDI in healthcare?EDI is the automated transfer of data in a specific format following specific data content rules between a health care provider and Medicare, or between Medicare and another health care plan.
|
