White Paper Interoperability February 18, 2025 Orchestrate data refinery as a clinical data platform guide CareEvolution’s Orchestrate Data Platform is the healthcare industry’s gold standard for ingesting, harmonizing and improving patient data quality at any scale, including small use cases or massive enterprise solutions for payers, providers, life sciences, health tech, and consumers. It has been our mission for 22 years to make it easier and faster to access patient data all while improving the data quality to connect healthcare. This is all done at a pace that is unrivaled in the industry with our Cloud Native Orchestrate technology stack. We have clients that are in production with our APIs in literally hours. (Forward this to one of your developers to try.) We are obsessed with making software tools that can be quickly implemented to accelerate our clients’ data driven use cases. Orchestrate is a rich set of data pipelines and containers that enable multiple application use cases From ingestion and aggregation of raw data, to standardization and harmonization of disparate data types—Orchestrate catalyzes and enables your data use cases. Orchestrate is designed to manage and refine healthcare data through a comprehensive 6-step process, ensuring that data is collected, organized, standardized, and transformed efficiently. These steps are integral to the platform’s ability to handle complex healthcare data across various systems. We have cracked the code on the complexity of data ingestion at any scale Our software has established connectivity to nearly EVERY data source in the industry enabling RAPID data ingestion. Sample differentiators Benefits Sample differentiators Forgivingly accommodates variations across the industry data sources Benefits Eliminates the manual templating(cost) and customizations needed to process and uplift data. Across the majority of sources across the entire industry (Most HIEs like GaHIN, Epic, Allscripts, Athena, Cerner, and many more) Sample differentiatorsElegant error handling and Observability to keep data flowing Benefits Reduce Fire drills and Archeological digs: Providing warnings/errors instead of failing the entire document. Informs IT to help the business operators Sample differentiators Extract datetimes even when they are sent in non-standard formats Benefits Eliminates custom date handlers or manual fixes: Ex: 2020-01, 202001, 2020-04-01, 2022050208-0400 Sample differentiators Non-standard or proprietary sections Benefits Eliminates the need for custom code handlers: We have support for the section templates from all flavors of CDA (HITSP C32, CDA R1.1, R2.1 and some IHE flavors …) Sample differentiators Continuously updating our APIs with improvements as we process BILLIONS of transactions annually Benefits Removes the ‘Break/Fix approach for the IT team by accruing the continuous updates to our APIs as changes occur across sources in the industry CareEvolution has reached across the entire nation to connect healthcare on behalf of our clients Connect to providers and health plans across the nation CareEvolution’s platform can reach over 85% of all U.S. healthcare delivered annually. Connect to EHR data from over 1.5 million providers and nearly all the leading national and regional health plans. See how researchers across life sciences are connecting to real world data. 250M+Patient records across clients 15B+ Continuity of care documents processed 6.5K+Health information technology interfaces Scaling health data orchestration Data is cleansed and standardized automatically, ensuring patient information is consistently matched, tracked across data sources with similar codes grouped together to make data analytically ready. Sample payer data flow perspective Common Orchestrate architectural themes No Data Left Behind: Orchestrate is first and foremost a data platform. The wider the variety of data we are able to aggregate and make accessible (payer, provider, public health, consumer device); the more complete a picture of a person is available—informing better decision making and quality. Data Provenance: Data is persisted as received with minimal modification/preprocessing. This enables greater traceability, flexibility and usability. It also keeps the process of on-ramping new data feeds simple. Interoperability/Standard Compliance: MU Certified, IHE Standards (XDS, CCDA, etc.), FHIR, SMART, HL7, Direct, Standard Terminologies (ICD10, HCPCS/CPT, RxNorm, NDC, LOINC), NPPES. Decreases onramping cost for standard compliant partners. Allows an easier path to deriving value from data. Compliance with patient, payer, API access requirements. COTS/Cloud Native/SaaS/API enablement: Depending on client use cases, parts of the system can be enabled/disabled as needed. Roles/screens/reports/dashboards can be configured as needed, or re-used from our standard library. Over the last two decades we have accumulated many valuable insights on healthcare data and modern software solutions that can streamline operations, enhance decision-making, and drive better patient outcomes. 7 Clinical data challenges facing payers and how to solve them Cracks in the pipes: 6 steps to evaluating healthcare data curation and enrichment software Enabling business and technical value for payers Value levers enabled by Orchestrate Learn more about CMS Stars and risk adjustment: Safe Evolution: How risk adjustment and CMS Stars leaders can quickly innovate without compromise Ensuring EHR data integrity and accuracy for CMS Stars Ratings Why risk adjustment teams are upgrading to API technology Sample value lever details Use Cases Bidirectional Insights At the point of care, present providers with a list of patients, their care gaps, and conditions where additional documentation is likely needed EMR Care Gaps Quality Performance Use clinical data to close care gaps by delivering them to the right part of the members’ care team at the right time and improve the overall quality of the network Care Gaps Care Management Deliver near-time ADT feeds from providers for care management teams to engage high-risk patients and drive care plan adherence ADT Care Gaps Payment Integrity Connecting to EMR to instantaneously extract itemized bill for medical record as needed for detailed claim evaluation and potential to push PI insights at the point of care and claim submission to improve member experience and first-time claim acceptance and reduce denials EMR Risk Adjustment Source charts from connected EMRs to reduce chart chase and reliance on vendors, and reduce the cost of care Care Gaps Home Health Potential to share member data including SDoH with home health providers and data from home health and wearables to providers EMR Prior Authorization Automate prior authorizations for areas such as radiology, cardiology, and Rx through retrieving clinical data to generate charts and reviewing using AI tools EMR Out-of-Network Transfers Potential to use ADT information to initiate transfer from OON facility to in-network facility ADT Social Drivers of Health Potential to provide members and providers with information about community resources and benefit availability through SDoH data and enable better care at home EMR Enabler EMR Ingesting data from and delivering data to leading EMRs and related applications to ensure latest information is available across all points of care and create a Longitudinal Patient Record (LPR) ADT Admissions, discharges, and transfers data feeds include notifications and observations for patients allowing for real-time notifications and interventions Care Gaps Patient care gaps and AI-driven insights to improve patient health outcomes, drive engagement, and inform all stakeholders with next best action recommendations Use case spotlight: Bidirectional care gaps and gap actions in provider workflows Wherever possible we deliver the gaps-in-care, risk score, or patient stratification worklists within the native workflow used by the clinicians (Example below: Athena care coordination workflows) such that the clinician is not required to leave their tool of choice to benefit from the analytics being produced by the solution as well as appointment scheduling messages which trigger the request for care and coding gaps information. Digital ecosystem for healthcare innovation™ Across a range of end markets, our platforms enable adopters to accelerate the pace of their innovation. We serve multiple end markets and manage over 250 million US patient lives today. Health Data Orchestration Beyond basic connectivity and exchange, CareEvolution’s data management of Interoperability solutions enables analytics for provider-payer-consumer convergence on an enterprise-level. Digital Clinical Trials Enables researchers the ability to achieve agility, speed, and reliability – launching digital health trials and studies in hours (not days, weeks, or months).
