Developing a Scalable Infrastructure for Clinical Data at HIMSS23

The energy and exuberance generated at the recent HIMSS23 Global Health Conference & Exhibition in Chicago were palpable. It was an incredible opportunity to meet and build relationships during panel discussions, over meals, and in between education sessions. To gather as a community that shares similar interests in helping to improve the healthcare ecosystem for a healthier tomorrow was inspiring.

One common goal that emerged at the conference is the desire to leverage clinical data for better decisions and a more efficient healthcare system. In fact, a frequent theme throughout the panels and conversations at HIMSS23 was how to build a data enterprise and robust data management infrastructure. As the floodgates of data continue to open, there is a renewed sense of urgency around leveraging and deploying data in an efficient, effective, and scalable manner. But how do organizations stitch together disparate data assets from multiple data and application sources, build enrichments around that data, and then extract insights that ultimately are delivered to a data consumer in the right format, in the right place, and at the right time?

I had the honor of co-presenting an education session on “Scalable Infrastructure for Clinical Data Interoperability & Patient Access” with Rob Low, Divisional Senior Vice President and Head of Data & Analytics at the Health Care Service Corporation (HCSC). HCSC is the fourth largest health insurance company in the U.S. and serves nearly 17 million members across five states and employs nearly 24,000 people in over 60 local offices. During the presentation we explored the driving forces propelling digital transformation of clinical data infrastructure, as well as the challenges health plans and providers are experiencing to successfully leverage clinical data due to silos, fragmentation, and quality issues.

In 2020, the Centers for Medicare & Medicaid Services (CMS) released the Interoperability and Patient Access final rule, which established the requirement for healthcare providers to supply direct access to patients’ electronic medical records via APIs. Many providers and health plans turned to interoperability solutions to support compliance with this mandate by July 1, 2021, and prepare to exchange data in the new Fast Healthcare Interoperability (FHIR®) standard.  

At the time, HCSC, like many health plans, lacked the infrastructure to manage, standardize, and convert massive amounts of legacy data streams into FHIR resources to support patients’ access to their medical records. Clinical data management is crucial for health plans to effectively serve their members, but it is a notoriously messy process due to the inconsistent way in which clinical data is typically captured within the electronic medical record. HCSC receives billions of clinical data records in different formats from countless sources making it difficult for the organization to tap into the potential of its clinical data to transform care delivery and health outcomes.

During the presentation, Rob discussed his collaboration with Availity, where he utilized Availity Fusion™, our API and cloud-based technology, to semantically standardize, enhance, and consolidate comprehensive clinical data sets. This partnership ensured CMS compliance within the original deadline. HCSC designed a scalable, enterprise-level clinical data infrastructure that standardized, enriched, and converted 420 million historical data records, including CCDs HL7v2 messages, and FHIR resources, into six billion analytics-ready FHIR resources within three months. 

As a pioneer of healthcare innovation, HCSC understands that the importance of using high-quality and interoperable clinical data assets as the foundation for a long-term data strategy is critical for improving health outcomes beyond Patient Access. By building on the data assets created for compliance with the Patient Access mandate, healthcare organizations can design a valuable resource that can be used to drive insights and inform decision-making across the healthcare ecosystem. For instance, predictive analytics fueled by high-quality data can be used to identify patients at high risk of developing certain diseases, enabling health plans and clinicians to intervene early and prevent the onset of illness by designing tailored care management programs and empowering patients to be proactive participants in maintaining their health.

The healthcare industry continues to have big problems to solve. Bending the cost curve. Disparities in health outcomes and access to quality healthcare. Enabling real-time and secure data exchange at scale. Powering automation and predictive analytics to improve patient outcomes. Providing a delightful healthcare experience for patients and providers. But being at HIMSS23 among the healthcare community reminded me that it takes a village to solve complex problems like these. And that we are making progress. To continue the momentum, we must leverage our combined intellectual capital and technological capabilities to solve them together.

Availity Fusion is a critical piece in the broader solution set to enable a robust data infrastructure and enterprise. Successful data management requires a flexible data fabric architecture that includes data integration pipelines, semantic normalization, and data enrichment to support financial, clinical, and operational use cases that can be delivered across multiple deployment and orchestration platforms.

Download our latest insight brief “Designing a Long-Term Strategy to Empower a Better Overall Health Care Ecosystem” to learn how data fragmentations, silos, and quality issues impact whole person care and how innovative healthcare organizations can utilize high-quality data as the cornerstone for their long-term data strategy. 

Ashley Basile, Ph.D., Chief Product Officer of Clinical Solutions at Availity 

As Chief Product Officer of Clinical Solutions, Ashley is responsible for corporate and product strategy, and leads the product management, clinical informatics, and marketing teams. Ashley brings over fifteen years’ experience in senior product and strategy leadership to her role at Availity.