Gartner recently listed HealthLX as a Representative Vendor in clinical data integration in its Clinical Data Integration Capabilities and Sourcing Recommendations for U.S. Healthcare Payers.*
As federally mandated interoperability deadlines approach, payers continue to struggle to bring clinical data initiatives (CDI) to fruition.
According to Gartner,
“Clinical data integration (CDI) is a complex value chain, not a single process. Each step in the value chain requires specialized skills that may not be accessible internally.
Payer IT and business leaders underestimate the complexity of the CDI value chain, which leads to overpromising and failing to deliver target business outcomes.
While there are an increasing number of CDI vendors offering solutions across the value chain, the vendor landscape is heavily specialized and requires nuanced evaluation. “
The report noted, “Although they are closely related, Gartner defines interoperability and clinical data integration as separate and distinct capabilities:
Interoperability is the capability to exchange data among healthcare organizations, inclusive of the standards, processes and technologies that support it.
Clinical data integration (CDI) encompasses the ingestion and handling of interoperable clinical data into the payer environment. CDI consists of seven sequential processes forming a value chain: consent, acquisition, standardization, normalization, integration, enterprise application deployment and use-case application.”
“Compliance with the CMS Interoperability and Patient Access final rule and ONC's 21st Century Cures Act final rule has multiple facets, each of which can be a significant data management challenge on its own for payers,” said Will Tesch, CEO of HealthLX. “This Gartner report couldn’t be more timely in illuminating the complexities of both CDI and interoperability and providing strategies for payers to troubleshoot their efforts to date and identify solutions for moving forward quickly.”
Gartner stated, “The recent ONC and CMS regulatory mandates anoint FHIR as the cross-sector standard for interoperable healthcare data — but that doesn’t make FHIR a panacea for scaling CDI. Until FHIR is ubiquitously adopted for revenue-based practices (such as quality and risk reporting) as well as administrative processes (such as prior authorization submissions), CDI initiatives will continue to struggle with multi-format complexity.
Enterprise CDI strategy should consider two scenarios: FHIR becomes the lingua franca for healthcare or FHIR fizzles due to implementation challenges. Gartner believes FHIR will persist, expand and accelerate interoperability improvements across the ecosystem and we encourage scenario planning to prepare for any necessary pivot.”
“As a founding member of Health Level Seven International's (HL7) Da Vinci Project, we have seen the efficacy of the FHIR standards and firmly believe FHIR is and will continue to be an essential driver for interoperability,” said Tesch, “not only because it satisfies the traditional communication needs for payers and providers, but also because it supports the principles underlying the composable data architecture of the future. HealthLX’s FHIR Enterprise is operational, and we are partnering with payers nationwide to help them move along the value chain to CDI and go that last mile to achieve interoperability quickly and without the need for a custom solution.”
*Gartner, “Clinical Data Integration Capabilities and Sourcing Recommendations for U.S. Healthcare Payers,” Mandi Bishop and Rohan Sinha, 3 April 2021.
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