Patients have been frustrated by the lack of transparency in the U.S. healthcare system for years. It’s unclear where their personal health information (PHI) lives, who has access to it, how it’s used and if and when it can be transferred among providers. A lack of interoperability can open the door to poor health outcomes — and it’s one of the problems that the 21st Century Cures Act aims to solve.
Healthcare organizations across the care continuum — including hospitals, health systems and health insurers — must digitally transform in order to abide by the Act’s information security and standardization requirements. However, this transformation requires connectivity across an ever-increasing number of applications, data, and devices which has long been a challenge for the industry.
To begin tackling connectivity issues, a growing number of healthcare organizations have adopted API-led connectivity including HL7, a messaging standard that enables clinical applications to securely exchange data. In 2014, an important alternative to the HL7 standard, was introduced — the Fast Healthcare Interoperability Resources (FHIR) standard. FHIR builds on previous data format standards from HL7, but it is easier to implement because it uses a modern web-based suite of API technology.
While VerityStream is not a hospital, health system or health insurer directly impacted by the 21st Century Cures Act, we recognize the importance of transferring data to improve overall quality of patient care. As such, we have launched the Epic Provider Validate App - enabled by FHIR - to support the secure flow of provider data into your Epic EHR solution. The App delivers an easy to use “Provider not in the system workflow” that Epic users can trust to monitor Referring Providers and Referring Clinics. With Provider Validate, you can verify sanctions and exclusions and check licensing and board certifications in one, centralized location.
Once installed, Provider Validate sits right within your Epic solution. When you receive the message “Provider Not in System” — simply click on the Provider Validate button. A sidebar opens where you can then enter the Referring Provider or Clinic’s NPI. Provider Validate will then confirm that the provider is truly not in the system. And, if not located, it will get to work validating the provider.
To do so, Provider Validate taps into VerityStream Validated Providers: our database of pre-validated profiles for millions of physicians, nurse practitioners, physician assistants, and other care givers. VVP utilizes innovative technology to ensure this database is updated continuously based on primary source verifications from federal verification and exclusion lists, licensing and specialty boards, and integrated partners like the Federation of State Medical Boards (FSMB).
Once Provider Validate locates the referring provider, demographic data is displayed for review. Warning messages will appear to alert you if any issues due to OIG, SAM "black list", or NPPES/FSMB deactivation exist. Once you confirm the provider and their data, Provider Validate will send the validated information to your Epic Master Provider File and an associated SER record and FHIR address will be created.
In the future, we recognize that Referring Providers may play a role delivering care to your patients. With advances in telehealth, these providers may attend to your patients remotely while being treated in your facilities. In that case, you will want to exercise credentialing to ensure that these providers are qualified to deliver the appropriate level of care. Functionality enabling you to transition Referring Providers to External Order Providers will be available in the Epic Provider Validate App in 2022.
We all win when healthcare information is more accessible and transparent. Contact a VerityStream Solution Representative today to learn more about CredentialStream, the Epic Provider Validate App, and how we are taking advantage of FHIR technology to improve communication across the healthcare continuum.