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Diameter Health’s FHIR Patient Access Solution Enables Payer Compliance with Federal Interoperability Requirements

07/29/2020

Turnkey solution saves payers time and expense while improving member satisfaction

FARMINGTON, Conn.July 29, 2020 /PRNewswire/ — Diameter Health, the standard for clinical data optimization, today announced the launch of its FHIR Patient Access solution that enables payers to comply with federal regulatory requirements to provide members with access to their health data using FHIR standards.

Diameter Health’s FHIR Patient Access is a turnkey solution that gathers clinical, cost and encounter data and provisions it to members using the FHIR (Release 4) standard, with the required Smart on FHIR security framework. FHIR Patient Access is built on Fusion, Diameter Health’s clinical data refinery, which provides high-quality data for real-time applications such as prior authorization and clinical care, as well as retrospective reporting and analytics for population health.

The solution helps payers comply with new regulations issued by the Centers for Medicare & Medicaid Services (CMS) that require insurers offering Medicare or Medicaid plans to implement and maintain a secure, FHIR Patient Access Application Programming Interface (API) that enables members to easily access cost data, encounter information, and clinical data. Enforcement of these regulations is scheduled to begin on July 1, 2021.

A recent Gartner report, titled “Prepare for CMS Interoperability and Patient Access API Compliance for U.S. Healthcare Payers,” detailed many of the challenges payers are likely to face in complying with the new regulations, and recommends that payers consider partnering with vendors to achieve success.

“Given the aggressive timeline to implement the Patient Access API, the immaturity of the standards, the complexity of the rule and the net new payer processes, we strongly recommend that you evaluate vendor partners to help you achieve compliance,” states Gartner. Health plans and payers should “anticipate and mitigate the risk that member data access will expose data quality issues.”

As payers begin to share more complete clinical data with patients, it will also bring to light data quality issues that have thus far largely remained in the dark. Although payers are not responsible for the accuracy of clinical data obtained from other parties, members who encounter problems with data quality are more likely to have poor experiences and report lower satisfaction, potentially delivering a negative impact on payers’ Star ratings.

Diameter Health’s FHIR Patient Access solution addresses these issues.

  • Automatically converts and maps incoming data into FHIR formats
  • Refines high quality data that supports a better member experience
  • Integrates with FHIR-enabled mobile applications

“While these new regulations contribute to the laudable goal of creating a more patient-centered healthcare system, they also confront payers with several complex technical challenges in a compressed timeframe,” said Eric Rosow, chief executive officer and co-founder, Diameter Health. “Our experience indicates that member clinical data is often incomplete, redundant, or inconsistently coded, limiting its value for patient access via FHIR. Our FHIR Patient Access solution does far more than just provide data in the correct FHIR format. It normalizes and enriches raw clinical data so that information presented to the member is more accurate and complete.”

About Diameter Health

Diameter Health is the standard for clinical data optimization, transforming raw patient information into the highest quantity and quality of interoperable data for healthcare organizations. Powered by automated, scalable, auditable technology and a team of industry experts, Diameter Health delivers actionable and enriched clinical data that enables real-time transactions, improved analytics, reduced cost, and better care outcomes. The Diameter Health platform enables organizations that depend on multi-source clinical data streams, such as health plans, Health Information Exchanges (HIEs), healthcare IT, life insurers, and health systems to realize greater value from their data. For more information, visit www.diameterhealth.com or contact us at info@diameterhealth.com.

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