EHR Data Interface Issues for the Third Party Biller IS THE INDUSTRY MOVING AWAY FROM YOUR BILLING MODEL? By Ron Sterling hird party billers face a variety of business and technical challenges in interfacing with electronic health records (EHR) and other systems. Indeed, some of T the initiatives in the healthcare industry will continue to complicate the establishment and maintenance of data interfaces for the foreseeable future. BUSINESS CHALLENGES – if you go back a few years before meaningful use, there were over 1,200 practice management system (Pms) vendors and a couple of hundred ehr vendors. during that time, the third party billers and/or practice management system vendors had the access to, and the attention of, physicians who needed to get their claims out of the door and paid. consequently, it was the ehr vendors that would offer to accommodate interfaces with medical billing systems. indeed, a variety of Pms vendors touted their systems as a gateway to a variety of ehr options for their physician clients. today, newly introduced integrated Pms/ehr products and ehr acquisitions by Pms vendors and vice versa have led to fewer, if any, billing system options for many ehr buyers. from integrated systems (that by design and business model do not interface with other products), to vendors that will not interface with other options, many vendors have established themselves as one stop shops for medical billing, ehr solutions, and, in some cases, rcm services. indeed, some vendors have exclusive or “preferred” clearinghouse relationships for the handling of standard hiPaa transactions. in essence, more and more vendors want to position themselves as the only source for healthcare software solutions and services. that is not to say that there are not ehr vendors who are eager to interface with a variety of practice management systems. however, the industry is moving to fewer interfaced solutions and more integrated offerings. indeed, the majority of “new” solutions are integrated Pms/ehr offerings. HEALTHCARE INDUSTRY CHANGES – related to the business challenges, the meaningful use initiative will affect interface strategies for all Pms and ehr products. for example, stage 2 meaningful use core (required) measures include secure messaging with patients and providing electronic access to patient medical information. in most cases, this requires the use of a patient portal. Patient portals can provide both medical billing and clinical interactions with patients. as importantly, most patient portals are designed to interface with one product line of medical billing and ehr products (such as centricity Pms/ehr or nextgen ePm/ehr). Patient portals are not typically designed to interface with one vendor's practice management software containing billing data and a different vendor's ehr that houses clinical information. if the patient portal is separately interfaced with a Pms from one vendor and an ehr from a different vendor, the patient portal may not “know” how to properly route the message. in practice, however, patients may exchange secured messages with the practice on both billing and clinical issues. a strategy that may include a separate patient portal for clinical issues and one for medical billing purposes presents a variety of operational challenges, including coordinating patient access and even accurately routing information. as importantly, separate patient portals will undermine support for the Patient centered medical home and accountable care organizations. for example, a patient who accesses the medical billing patient portal may not be reminded about a clinically-driven patient service issue. TECHNICAL CHALLENGES – most interfaces are based on the health level 7 (hl7) structure. however, various aspects of hl7 are open to interpretation by vendors. indeed, a variety of Pms and ehr vendors do not strictly support the hl7 standard. for example, some vendors use general hl7 messages instead of designated hl7 messages to send information. in other instances, the information in a message is not placed in the expected place but in a comment or supplemental area. indeed, some vendors do not use the standard code sets, and instead use text fragments. in each case, the effort to establish the interface may require a painstaking evaluation of the vendor’s “hl7” implementation. even after achieving success, the interface may have to change to address evolving coordination of information requirements between the medical billing and clinical record functions. for example: 52 hbma billing • may. june.2013
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