Stream: implementers
Topic: Claims, FHIR, and EHRs
Daniel Tam (Jan 11 2022 at 23:55):
Hi, are there any providers who are using claims data to supplement clinical data in their EHRs? I generally think of claims and clinical data being siloed off, between the billing and the clinical data groups. But with FHIR and Claims Resources, are people seeing value in bring claims data into FHIR?
Are you extracting elements from the claim to add information to say a Procedure or Diagnosis resource?
Or are you storing the full claim in FHIR -- and if so what are you doing with that?
Michele Mottini (Jan 12 2022 at 00:16):
Our system aggregates both clinical and claim data and renders data coming from claims also as FHIR clinical resources, so if you have a claim for a patient listing some conditions and then you search for Condition for that patient you'll get back also those ones
Michele Mottini (Jan 12 2022 at 00:16):
...and we have both payer and providers using it
John Silva (Jan 12 2022 at 00:54):
Makes sense for use cases like overtreatment reduction, prior-auth (aka DaVinci Burden reduction), patient claim/ExpanationOfBenefit viewing (DaVinci Patient Cost Transparency?), and more to be discovered in an effort to reduce cost I imagine.
Lloyd McKenzie (Jan 12 2022 at 03:55):
I know there have been real-world-evidence projects that have integrated clinical and financial data. Note that whether you'll actually see financial data expressed in FHIR terms depends a bit on what jurisdiction you're in.
Daniel Tam (Jan 13 2022 at 00:45):
@Michele Mottini : Would you mind telling me more? Was curious if your system stores the claims as Claims FHIR resources?
Or are you solely parsing the claim, to extract things like ICD-10s and then creating Condition resource?
What else are you parsing from the claim?
@Lloyd McKenzie : Are you able to connect me with anyone working on those evidence projects? I was curious if these were in clinic settings or something else, like clinical trials or research?
Lloyd McKenzie (Jan 13 2022 at 04:45):
It was research. I'm not sure it's in production yet and I don't think I'm allowed to share details.
Daniel Venton (Jan 13 2022 at 13:18):
In our system we extract Conditions from EOB.diagnosis, Procedures from EOB.procedures, MedicationDispense from EOB(Rx).item.
Technically speaking all these resources are gathered from the claim submission, they just fill multiple resources.
Michele Mottini (Jan 13 2022 at 14:14):
No, we do not store data as FHIR, we have our own data model. We extract Conditions for EOB.diagnosis, Procedures from EOB.procedures, MedicationDispense and Immunization from EOB.item.
Cooper Thompson (Jan 13 2022 at 14:40):
We (Epic) also use claims data to supplement clinical data. Like Michele, we don't store things as FHIR, and I don't think we are commonly (if ever) using FHIR to transfer the claims (yet).
It seems like there are really two different questions you have:
- Is supplementing clinical data with claims data useful? I think the answer here is a definite "yes".
- How does that claim data get shipped between systems? FHIR is likely to be an increasingly common transmission method. But it isn't the only way.
You're also kinda asking about using FHIR as your internal storage format. But that is really a question about the internals of your system, and isn't really relevant for your industry partners. Though the question about using FHIR for storage does come up somewhat often, and there are folks who can provide the pros/cons of doing that.
Last updated: Apr 12 2022 at 19:14 UTC
