Universal Healthcare Data Integration and Validation System

The client faces significant difficulties due to disparate healthcare platforms processing and storing data differently, leading to challenges in real-time eligibility verification, coverage discovery, and data accuracy. They need a comprehensive solution to unify fractured medical data across various systems, ensure regulatory compliance, and improve operational efficiency.

A mid to large-sized healthcare organization seeking to unify and streamline fragmentation in patient data, insurance eligibility, and healthcare system interoperability.

• Develop a scalable platform capable of handling an unlimited volume of healthcare data from multiple sources.
• Implement real-time eligibility verification and coverage discovery for various insurance payers and long-term care facilities.
• Create standardized data mapping to facilitate smooth data exchange across diverse healthcare systems.
• Design a flexible scheduling and notification system to ensure timely updates and exception handling.
• Enhance data security and compliance with industry standards such as HIPAA, including encryption and multi-level access controls.
• Enable multi-platform accessibility to support healthcare operations on any device.

• High scalability microservices architecture supporting unlimited source and target systems.
• Standardized data mapping for accurate normalization across diverse healthcare data sources.
• A customizable scheduler allowing tailored data operations and exception handling.
• Real-time eligibility verification and coverage discovery modules.
• Smart notification system delivering timely updates to healthcare professionals across multiple devices.
• Robust security features including data encryption, access control levels, and compliance with HIPAA regulations.

• Electronic Medical Records (EMRs)
• Insurance payer systems (Medicare, Medicaid, commercial payers)
• Practice management systems
• Billing and therapy management platforms
• Long-term care facilities databases

• Platform must support unlimited data sources and users with high scalability.
• Real-time data processing with minimal latency.
• Strict adherence to security protocols, including data encryption and multi-level access controls, compliant with HIPAA.
• System uptime goal of 99.9% with reliable backup and disaster recovery measures.
• Cross-platform accessibility for users on any device.

The deployment of this healthcare data integration platform is expected to significantly improve operational efficiency, automate eligibility verification, and enhance data accuracy across multiple healthcare providers. Goals include supporting over 700 healthcare facilities, processing over 1 million transactions daily, and enabling seamless data interoperability that empowers healthcare professionals with up-to-date, reliable patient information, ultimately elevating the client’s market position and service quality.