FHIR Data Exchange Module for Medical Claims
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Solution Overview
Problem
The differences in field names, definitions, and value formats across various healthcare institutions hinder automatic data integration for insurance companies processing medical claims, leading to increased manual effort and prolonged waiting times for policyholders, and the sensitive nature of medical data complicates integration using public applications or online tools.
Innovation Solution
A system utilizing a data exchange module, blockchain database, and authority management module to convert raw medical data into FHIR-standard format, ensuring secure and interoperable data exchange and claims processing, employing encryption and decryption methods using public and private keys, and storing data in a blockchain database for secure access management.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If manual interpretation and format adjustment are performed by claims handlers, then data integration can be achieved, but the processing time increases from weeks to months and operational burden increases
Solution Approach 1:
The patent introduces an intermediary component (data exchange module with FHIR converter) that automatically transforms medical data from various formats into a standardized FHIR format. This intermediary handles the format conversion between different healthcare institutions' systems and the insurance company's claims processing system, eliminating the need for manual interpretation while ensuring accurate data integration.
Solution Approach 2:
The system changes the data format parameter from institution-specific formats to a standardized FHIR format. By transforming the structural parameters of medical data (field names, definitions, value formats) into a unified standard, the system enables automatic processing without manual intervention, thereby reducing processing time while maintaining integration accuracy.
2Ease of operation
If public applications or online tools are used for data conversion, then data integration becomes easier, but data security and privacy are compromised due to the sensitive nature of medical data
Solution Approach 1:
The patent implements a secure intermediary data exchange module that operates within the organization's controlled environment rather than using external public tools. This intermediary performs the necessary format conversions while keeping sensitive medical data within secure boundaries, thus maintaining both ease of operation through automation and data security by avoiding external exposure.
Solution Approach 2:
The system creates a secure, isolated environment (inert atmosphere) for data conversion operations. By implementing controlled access, encryption, and secure processing environments, the system enables automatic data integration while protecting sensitive medical information from external threats, thus achieving both operational ease and security.
3Adaptability or versatility
If different field names, definitions, and value formats are used across healthcare institutions, then each institution can maintain its own data standards, but automatic data integration becomes difficult requiring manual intervention
Solution Approach 1:
The patent implements a universal data exchange module that can handle multiple input formats from different healthcare institutions and convert them all to a standardized FHIR output format. This universal converter maintains the flexibility of institutional data standards while enabling automatic integration, as it can process various formats (XML, JSON, CSV, etc.) and map them to the common FHIR standard.
Solution Approach 2:
The system dynamically changes data parameters (field names, definitions, value formats) from institution-specific variations to a unified FHIR standard. The converter automatically adjusts these parameters based on the input format, enabling automatic integration while preserving the adaptability of source systems through configurable mapping rules.
Data Source
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AI summary
Disclosed herein is a system for implementing medical data exchange and medical claim settlement via Fast Healthcare Interoperability Resources (FHIR) standard data. The system includes a data exchange module, a blockchain database, a service-provider server, and an authority management module, all of which are communicatively connected to each other. The system receives and converts raw medical data into FHIR standard data for transmission to insurance institutions, and encrypts the FHIR standard data, and facilitates medical claims settlement. Also disclosed herein is a method for implementing medical data exchange and claims settlement based on FHIR standards.