Key Features
Standard healthcare transactions are used as the source data for Edifecs HTR.
After validation against the required standard, an extract, transform and load (ETL)
process is used to move all data into the business-normalized schema that is integrated across transaction types.
The repository uses an ontological or business-normalized conceptual approach to the storage of key healthcare data.
This approach assures an independent data storage for consistent retrieval and analysis regardless of the enterprise or system source of the transaction.
Additionally, this approach allows for a common storage of data content from multiple transaction types in a single database
and leverages these transactions to provide a rich source of business intelligence.
The Edifecs Healthcare Transaction Repository is comprised of the following components and services:
HTR Schema
The Edifecs HTR Schema can be deployed on Multiple RDBMS platforms including MSSQL, Oracle and DB2.
This schema is maintained to support all major healthcare transactions to assure complete storage of all transactional data.
The schema is designed to allow for the addition of data content without a significant disturbance in the underlying database structure.
Standard business views on top of the database provide an easy mechanism for extraction of data for analysis of mapping to other host systems.
Since the schema has been defined to represent standard healthcare concepts, mapping is straightforward and eliminates the need for
more complex and expensive traditional EDI translation. The Edifecs HTR Schema provides an operational data store that is optimized for
rapid load and accessibility. The schema also provides a historical database that can store several years of data for trending and other analysis.
This schema is fully documented with a rich set of accessible metadata.
Transmission File Repository
As transmitted files are received, they are stored in an unaltered format in the Edifecs Transmission File Repository for retrieval at any time.
A link is established between the transmission file and all normalized data content in the Healthcare Transaction Repository.
This link provides the ability to retrieve any transmitted file or set of files based on any content in the transactions.
The Transmission File Repository assures that there is traceability for transactions regardless of the down-stream processing
of the transaction content in host systems.
Error Repository Services
All errors that are generated as a result of the validation, ETL or post-load rules are stored and associated with the appropriate
transactional component in the repository. Analysis of these errors can leverage Edifecs HTR to define error patterns based
on any defined dimension in the repository. For example, errors can be grouped, ranked and trended by submitter.
For any submitter, the type of errors can be defined and for any given error the data values that created the error may be analyzed.
Event Tracking Services
Edifecs HTR also stores event data related to any part of the transmission or transaction and relates
these events to the transmission content down to the level of the individual data element, depending on the type of event.
Events could include transmission receipt, encryption, external processing, validation, splitting, routing or any number of
other events that might occur to the file or any component of the file during the transaction lifecycle. Analysis of the impact
of any processing event is facilitated since the association of the event to the transaction content is easily determined.
Code Set Services
Most healthcare transactions are highly coded. The definition of these code sets is critical to arriving at proper informational
representation of the data elements. Code set aggregation schemes assure proper grouping of codes based on a variety of national
standards or proprietary aggregation models. Edifecs has an ongoing code set maintenance process to assure that code definitions,
aggregations and other code representations are current and accurate. Code set rules assure that codes are applied appropriately to
the correct elements based on standards definitions.
Validation Services
Edifecs XEngine provides a production stream validation of all healthcare transactions as they enter or leave
the enterprise to assure that transactions comply with both HIPAA and payer-specific guidelines.
As part of the validation process, Edifecs XEngine is able to split transactions into “Good” and “Bad” content so that
valid transaction content may be accepted while invalid content may be rejected, with the appropriate acknowledgements generated.
Edifecs SpecBuilder provides a companion guide specification authoring tool that allows the customer to customize rules and configure
criteria for acceptance. The rules and configurations defined in this tool provide both human and machine readable outputs.
Edifecs XEngine uses the machine readable output to provide its validation services. The output of Edifecs XEngine provides
the input for the Edifecs Healthcare Transaction Repository and assures quality and integrity of the data stored in the repository.
ETL Services
The process of extraction, transformation and loading of standard transaction data is complex and requires an
extensive set of rules to assure that data is properly defined and loaded into the Edifecs Transaction Healthcare Repository.
Edifecs has defined over 3000 individually tabled rules that drive the ETL process. These rules assure that reporting and analysis
of this data is consistent and accurate. As transaction standards change and new transactions are added, Edifecs updates these rules
to ensure that the data content of all transactions continues to be appropriately loaded into the repository.
The customer can be assured that as transaction versions or sources change, service lines or similar transaction elements
will continue to be defined appropriately in the repository.
Indexing Services
As data is loaded into the repository, potentially millions of instances of provider, person, payer and event data are loaded.
These instances are indexed so that providers, payers, entities, persons and events can be used as dimensions for analysis.
Indexing also provides the opportunity to create crosswalks to identifiers and other key attributes based on the transactional data.
For example, if a provider submits any number of claims over a period of time and uses a number of identifiers, including a National Provider Identifier,
the indexing process automatically creates a crosswalk for that provider between the NPI and any other identifiers or submitted attributes for that provider. Indexing provides for efficient analysis of data by tagging transactional data to key entities and events.
Security Services
The Edifecs Healthcare Transaction Repository not only assures the robust security support that any large RDBMS system offers,
but also provides access control through “data ownership” assignment. This assignment is accomplished through the association of users to
the appropriate indexed entity to assure that access is limited to the appropriate data dimensions.
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