Although adopting personal health information and records is a goal of most national and state efforts, virtually all RHIO’s, community health networks, hospital systems and provider practices are all falling short of adoption due to disparate systems, lack of vision, varying data formats, data sharing issues, etc.
In New Jersey, the Department of Banking and Insurance has the ability to facilitate the creation and use of electronic health records statewide, with an unprecedented approach. Pursuant to N.J.S.A. 17B:30-23 et seq.
The healthcare payers would deny payment for any medical claim submitted without being accompanied by an electronic attachment that sets forth: test results, finding, laboratory values, images, diagnostic codes, or does not permit immediate electronic access to said test results by the patient and properly authorized providers.
Once the use of such a process is enforced, the model below would be adopted to share or deliver the electronic health records between healthcare trading partners:
Administrative rules to establish a secure Internet based HEALTH WEB, where all eHR information for covered persons can be accessed. The Health Web will consist of participating entities, Payers, Labs, PBM, IDN etc. connected over a secure network. The Health Web core system will be consist of a Virtual MPI Search Engine, MPI Database, Health Routing Engine, Translation and most importantly the Provider’s Secure Access component.
The above mandates will allow Payers to become eHR data aggregators. A payer can mine and warehouse the collected medical results from trading partners, as well as claims from their Adjudication system.
Healthcare professionals will access the Health Web portal via a secure sign on and will have the capability to request information for a given patient by Member ID, Last Name, First Name, Middle Name, Date of Birth, Gender and State of Residence.
The Electronic Health Record will be built dynamically by collecting the information from all the participating entities. |
