Healthcare and EDI: A Match Made in Data Heaven

January 29, 2019

Electronic Data Interchange (EDI), has been around for decades.  It is a process through which data is exchanged in a standardized and structured format so that different data systems can contain the same information almost instantly. A good comparison might be the way a person speaking English might communicate with a person speaking Russian. They often need a middleman to serve as a translator for both. That’s what EDI does for systems – serves as the middleman so that system A can synchronize data with system B seamlessly.

Several standards exist to format the interchangeable data between systems. Some major sets of EDI standards, include:

  • The UN-recommended UN/EDIFACT, the only international standard, predominant outside of North America
  • The US standard ANSI ASC X12 (X12), which is predominant in North America
  • GS1 – An EDI set of standards predominant in global supply chains
  • The TRADACOMS standard,developed by the ANA (Article Number Association now known as GS1 UK).  It is ominant in the UK retail industry
  • The ODETTE standard, used within the European automotive industry
  • The VDA standard, used within the European automotive industry mainly in Germany
  • The HL7, a semantic interoperability standard used for healthcare administrative data.

We use EDI in many industries where standard data exchange is needed, and a key industry is healthcare. It is critical for the healthcare industry to adopt EDI-enabled systems, such as ONC Certified EHR systems and HIPAA X12 compliant billing systems, since the exchange of data between providers, payers and patients is critical. The adoption of these systems has a direct impact on all parties involved.

Here is a simple example of how EDI can help your visit to the doctor be more rewarding:

Imagine if you went to the cardiologist for the first time because of a recently diagnosed condition – a condition for which you have visited your primary care provider a couple of times. Your social history, demographic and medical history data will be asked by the cardiologist.  However, that information already exists in the primary care provider’s Electronic Health Record (EHR) system.  Using EDI, your cardiologist could receive this information in just a few seconds, enabling him to better focus on your condition, instead of wasting time asking questions you already answered somewhere else. And, since a good doctor cannot make a good diagnosis without all the necessary facts, the doctor can rest assured that he is receiving accurate information

The main goal of EDI in healthcare is to provide up-to-date information on a patient’s condition across the healthcare ecosystem. It helps reduce common mistakes that often occur when handling patient information and helps reduce fraudulent behavior by both the providers and the payers.

As an EDI senior software developer with over 11 years of experience, I have seen first-hand the complexity that is involved with EDI and all the challenges it still has yet to address.  But what if Artificial Intelligence (AI) was included in the mix, helping EDI developers create better and more efficient systems?  This could lead to better and faster communication between systems and go beyond the boundaries of formats and standards.  AI could help improve the way healthcare systems communicate with each other and fill in the gaps when additional information may be required.

As an example, take the interoperability standard, HL7, which contains two different versions that both can be used at the same time.  The two versions allow for the transmission of different types of data.  With the proper AI implementation, a developer could quickly close the gap between both formats by relying on the AI capabilities to determine the required output regardless of the versions and then just validating that the output is the expected one.  This would significantly reduce development time along the way.

EDI has transformed the way data is shared in healthcare for improved patient outcomes, streamlined processes and reduced healthcare costs. Making it smarter through the use of AI can go a long way to putting these benefits into overdrive.

 

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One Response to “Healthcare and EDI: A Match Made in Data Heaven”

  1. Jonathan Royce

    Yes, you are absolutely correct in this topic, the involvement of EDI in healthcare is completely undeniable. A very detailed observation.

    Reply