eHealth Exchange Recognized in KLAS Case Study for Advancing Networked FHIR in Provider-Payer Health Data Exchange

UC Davis Health and Regence Leverage eHealth Exchange to Automate Prior Authorization Approval Process

VIENNA, Va., May 09, 2024 (GLOBE NEWSWIRE) -- eHealth Exchange is identified as an influential convener advancing the HL7® Fast Healthcare Interoperability Resources® (FHIR®) standard by independent analyst firm KLAS Research.

The KLAS “Points of Light 2024 Case Study 18: Automating Prior Authorizations through Networked FHIR Connections” highlights how eHealth Exchange convened hospital systems such as UC Davis Health, payers such as Regence, other Qualified Health Information Networks™ (QHINs™), and the HL7® Da Vinci Project “to facilitate faster, easier data sharing through FHIR technology.”

“We continue to support an open and shared approach to solving payer and health exchange challenges, and this case study demonstrates how we consistently work together with key stakeholders to advance FHIR,” said Jay Nakashima, president of eHealth Exchange. “Together we can advance interoperability for the public good and accelerate prior authorization determinations to administer faster patient treatment.” Nakashima continues, “This is a critical move given the January 2027 compliance deadline with the CMS Interoperability and Prior Authorization final rule (CMS-0057-F) requiring providers and payers to exchange using FHIR for prior authorization.”

The KLAS case study, released in May, points to the outcomes achieved via this strategic collaboration, stating: “The process validated that QHINs can facilitate transaction requests between payer and provider organizations to promote the scaling of interoperability solutions.” This will have a significant impact on workflows associated with payment, prior authorization, and medical review, reducing administrative burdens on both parties while expediting patient treatment.

The federally endorsed Trusted Exchange Framework and Common Agreement℠ (TEFCA℠) encourages providers and payers to exchange patient data, specifically supporting the FHIR standard first in their FHIR Roadmap and again in version 2.0 of the Common Agreement released this past month. As the largest healthcare information network in the county and a Designated QHIN™, eHealth Exchange is paving the way for provider-payer health information exchange using Networked FHIR with its electronic data-sharing network.

eHealth Exchange recently launched an incentive program to encourage greater adoption of FHIR technology, offering to waive monthly fees for providers and payers exchanging data using FHIR according to the Da Vinci specifications. Although TEFCA participation by payers, providers, and public health agencies is currently optional, eHealth Exchange is accelerating the use of FHIR so network participants can begin reaping the benefits of this much-needed exchange now. eHealth Exchange payer and provider participants are striving to be in production with this new prior authorization process by the end of summer.

About the eHealth Exchange
eHealth Exchange, a 501(c)3 non-profit dedicated to public good, is the oldest and largest health information network in the country and is most well known as the principal way the federal government exchanges clinical data among federal agencies and with the private sector. Recognized for certified data quality, trusted governance, transparency, and its commitment to privacy, eHealth Exchange facilitates the secure exchange of patient records for more than 250 million patients and processes roughly 21 billion data exchanges annually. Vendor-agnostic, with a broad public health focus, eHealth Exchange provides connectivity for more than 30 electronic health record systems, 60 regional and state HIEs, 75 percent of U.S. hospitals, 85 percent of dialysis centers, 70,000 medical groups, and payers in 34 states – as well as countless urgent care centers, surgery centers, and clinical laboratories. Five federal agencies (Department of Veterans Affairs, Department of Defense, Indian Health Service (IHS), Food and Drug Administration, and Social Security Administration) also participate in the network to share patient information with private-sector partners as well as other federal agencies. Active in all 50 states, eHealth Exchange connects to other national health information networks today via Carequality and now TEFCA as a Designated QHIN. See: / @ehealthexchange.

Tina FeldmannJane Bryant
eHealth ExchangeSpire Communications