HCSC & Availity Partner to Accelerate Fast Healthcare Interoperability Resources (FHIR®) Compliance and Use of High-quality, Standard Data to Advance Clinical Data Accelerator Program

Overview

Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), and an Independent Licensee of the Blue Cross and Blue Shield Association, is the largest customer-owned health insurer in the United States, which operates Blue Cross and Blue Shield® Plans in Illinois, Montana, New Mexico, Oklahoma, and Texas. 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.

The Challenge

The Centers for Medicare & Medicaid Services (CMS) Interoperability and Patient Access final rule established the requirement for healthcare providers to provide patients with direct access to their electronic medical records upon request. Many providers and health plans turned to interoperability solutions to comply with this mandate by July 1, 2021. At the time, HCSC lacked a technology solution with the ability to ingest, standardize, and manage myriad clinical data streams and that effectively converted legacy data formats to FHIR.

The Availity Solution

To meet the July 1 deadline, HCSC chose to deploy Availity Fusion at the enterprise level to support a holistic Clinical Data Accelerator program strategy. Availity Fusion is an API, cloud-based technology engine that automates clinical data integration, normalization, and enrichment in real time and at scale through a comprehensive five-step process known as Upcycling Data.™ This includes improvement and transformation of large volumes of multi-source, multi-format data—such as CCD, HL7v2, and Flat Files—into standard output formats, including analytics-ready FHIR resources, to enable multiple use cases.

Key Results

• +420 million historical data records loaded, standardized, and converted to FHIR with real-time conversion in less than three months.
• +6 billion FHIR resources produced from historical data load in under three months to meet the July 1 deadline.
• Implemented a FHIR-eventing integration capability to continuously push updated clinical information and power the Clinical Data Accelerator strategy, accelerating key initiatives: Patient Access, Quality Improvement, and Development and Research for Care Improvement.

FHIR-eventing integration works by using FHIR messaging to send event notifications from one covered entity system to another authorized system. For example, a hospital’s electronic health record (EHR) system could send an event notification to a physician’s EHR system when a patient is admitted to the hospital. The physician could then receive this notification in real-time, allowing them to coordinate care with the hospital and provide timely interventions as needed.