Care Evolution

Health plans have long shouldered the operational burden of standardizing patient data—a time-intensive process critical to identifying care gaps. For teams relying on EHR data, such as those managing HEDIS (Healthcare Effectiveness Data and Information Set) measures, unstructured and uncoded data buried in disparate records pose significant risk of critical insight being left out of HEDIS measures. This translates into flawed decisions and missed care opportunities. Fortunately, advanced solutions now make it possible to automate the extraction and standardization of unstructured data, building a more comprehensive view of patient health.

Shifting Focus from managing data to identifying gaps in care

The National Committee for Quality Assurance (NCQA) emphasizes that the future of HEDIS depends on three pillars: better data, standardized measure calculations, and patient-centered, outcome-focused metrics. Modern patient data management APIs play a pivotal role in this transformation.

For example, the Orchestrate APIs standardize clinical data to comply with coding standards and add all applicable codes to unstructured and free text data. The result? More accurate and complete records are fed into HEDIS reporting engines – empowering teams to focus on making more informed quality decisions that improve care outcomes. By automating the organization and standardization of data, these APIs enable teams to focus on addressing gaps in care rather than struggling to manage and fill gaps in data.

How APIs automatically standardize data for HEDIS reporting

HEDIS teams can use Orchestrate’s Convert API to standardize and enrich data elements to feed higher quality and more complete data into their HEDIS engines. Orchestrate’s self-service APIs allow anyone managing patient data for HEDIS measure reporting to quickly and automatically:

1. Liberate Data: Access patient data from multiple sources like EHRs, HL7, CCDAs, and more.
2. Organize & Standardize: Aggregate and align disparate data points, including medications, labs, and diagnoses.
3. Classify & Analyze: Convert uncoded information into usable, standardized elements using standard ontologies and code reference systems like ICD-10, SNOMED, and RxNorm.

Organize & Standardize

The HEDIS team invokes the Convert API to organize and standardize and enrich data elements to feed higher quality data to their HEDIS Engine.

How APIs offer ‘Safe Innovation’ for HEDIS Leaders

Innovation doesn’t always have to be disruptive. In fact, for payers, the type of “safe innovation” offered by external APIs is the key to quickly improving the accuracy of care quality decisions that rely on clinical data.

By leveraging tools like the Orchestrate APIs, which integrate seamlessly into existing infrastructure, HEDIS teams can quickly improve data quality without risking the stability of their current operations. This approach allows them to build on what already works while gradually incorporating new technologies.

Conclusion

HEDIS teams can adopt the Orchestrate APIs to maximize data quality and unlock critical insights in their unstructured clinical data without the risk of an IT overhaul. And with better data comes better care.