Overview

The growing use of EDI transactions driven by HIPAA requirements and the demand for greater administrative efficiency has created a number of challenges and opportunities for the healthcare industry.

Challenges Faced by the Healthcare Industry

• HIPAA, Sarbanes-Oxley and other regulatory requirements are placing new demands on healthcare organizations around transaction integrity and accountability.
• There is no “gold standard” source of pristine, unaltered transaction data in most healthcare organizations, nor an audit trail for changes to the data as it moves through the multitude of processes inside the organization’s systems.
• Real time visibility into transactions as they flow through many organizational processing points and host systems is often limited by systems that are not fully integrated.
• Transaction exceptions that are processed manually after receipt have an inherent risk of “breaking the accountability chain” as they move from system to person back to system.

Opportunities for Healthcare Organizations

• Standardization of inbound and outbound transactions provides an opportunity to access and leverage data that meets the “gold standard” and that is truly independent of the source.
• Direct access to standardized transaction data can provide a new and powerful control point for all legacy system data.
• The potentially rich content of inbound and outbound transactions and their associated processing events can provide both an operational and historical data store for timely business intelligence across one enterprise, or even many enterprises.
• Linkages within transaction data or rules executed on the data can provide traceable points for action by operations, service lines or finance business units, and help identify new opportunities for business optimization.
• Each processing event can be associated with any component of the transaction to audit the transaction lifecycle in a standardized repository.