Clinical Claim Data Interchange Using Tokenized FHIR Access
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Solution Overview
Problem
In healthcare systems, the process of sharing clinical information between payers and submitters for claim processing is cumbersome, inefficient, and costly, often requiring multiple requests through third-party intermediaries, which increases time and resource consumption.
Innovation Solution
A financial/clinical data interchange system using a secure hash key and value pair data derived from medical claims, integrated with a blockchain network, enables direct access to patient encounter data via FHIR URI, reducing the need for intermediaries and enhancing data security and efficiency.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If a third-party intermediary is used to facilitate information exchange between payer and submitter, then data security and controlled access are improved, but transaction costs and processing time increase significantly
Solution Approach 1:
The patent implements a third-party data intermediary system that securely stores patient data and manages access requests. This intermediary enables the payer to obtain necessary clinical information without directly contacting the submitter, maintaining security controls while reducing processing time. The intermediary acts as a trusted mediator that facilitates efficient information exchange while preserving data protection.
2Reliability
If multiple requests are made through third-party intermediaries to obtain clinical information, then data access control is maintained, but transaction costs and resource consumption increase
Solution Approach 1:
The system performs preliminary actions by pre-establishing access permissions and data availability status through the intermediary before actual data requests are made. The payer can query the intermediary to determine if data is already available and accessible, avoiding unnecessary multiple requests and reducing computing resource consumption while maintaining access control integrity.
3Productivity
If direct access to submitter data is implemented, then processing speed improves, but data security and access control mechanisms are compromised
Solution Approach 1:
The patent employs a third-party data intermediary that enables the payer to access necessary clinical information directly from the intermediary's secure storage without contacting the submitter. This intermediary mechanism maintains data security and access control while significantly improving processing speed, as the payer can obtain data immediately from the intermediary without waiting for submitter responses.
4Adaptability or versatility
If a centralized data exchange system is used, then coordination and control are improved, but system complexity and implementation costs increase
Solution Approach 1:
The patent segments the data exchange system into distinct functional components: the submitter system that uploads data, the third-party intermediary that stores and manages access permissions, and the payer system that queries for information. This segmentation reduces overall system complexity by allowing each component to operate independently with well-defined interfaces, while maintaining coordination capability through the intermediary's access management functions.
Data Source
AI summary
Systems and methods for providing a financial/clinical data interchange are provided. The financial/clinical data interchange provides a distributed implementation to a secure hash key (i.e., a token) and value pair data derived from a medical claim (e.g., patient identification, submitter identification, payer identification, encounter identification, and the like) and enriched with submitter-based domain data. The token may be used as a data attribute in an API that unlocks a pointer to the value (e.g., a fast healthcare interoperability resources (FHIR) uniform resource identifier (URI) to the patient encounter associated with the claim) to leverage a FHIR query for all documented medical records associated with the claim the payer is authorized by the submitter to view.