Financial-Clinical Data Interchange Using Tokenized FHIR Access
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Solution Overview
Problem
Current healthcare systems require multiple requests and third-party intermediaries for clinical information exchange, leading to inefficiencies, high costs, and resource wastage in claim processing.
Innovation Solution
A financial/clinical data interchange system using a secure hash key and value pair data on an enterprise blockchain network, enabling 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 time and processing costs increase
Solution Approach 1:
The patent implements a blockchain-based intermediary system that acts as a decentralized mediator between payers and submitters. The blockchain network provides the necessary security and access control mechanisms while enabling direct peer-to-peer transactions, eliminating the need for traditional third-party intermediaries. This resolves the contradiction by maintaining security (through cryptographic protocols and access controls) while reducing transaction time (through direct interactions).
Solution Approach 2:
The patent replaces the mechanical system of traditional third-party intermediaries with a cryptographic and distributed ledger system. Instead of relying on organizational intermediaries to verify and facilitate transactions, the system uses blockchain's inherent security mechanisms (hash functions, digital signatures, consensus algorithms) to ensure data integrity and controlled access. This substitution eliminates the time delays associated with intermediary processing while maintaining security requirements.
2Loss of information
If multiple requests are made to obtain clinical information, then complete data is obtained, but processing costs and resource consumption increase
Solution Approach 1:
The patent implements preliminary action by pre-organizing clinical information into structured bundles on the blockchain network before claims processing occurs. The submitter can pre-upload and organize clinical data with appropriate access permissions, creating ready-to-retrieve information packages. When a payer needs clinical information, the data is already prepared and accessible in a single operation, eliminating the need for multiple requests and reducing processing costs while ensuring complete data retrieval.
Solution Approach 2:
The patent creates a universal data interchange system that serves multiple functions: storing clinical information, managing access permissions, enabling direct payer-submitter communication, and supporting various types of healthcare transactions. This multi-functional blockchain platform consolidates what would otherwise require multiple separate systems and requests, reducing overall processing costs while maintaining complete data availability.
3Adaptability or versatility
If traditional claim processing systems are used, then existing workflows are maintained, but efficiency and cost-effectiveness deteriorate
Solution Approach 1:
The blockchain-based interchange system is designed to be universal and compatible with existing healthcare workflows and standards. It can interface with various electronic health record systems, claims processing platforms, and healthcare information systems while providing enhanced efficiency. The system maintains adaptability to different organizational workflows while simultaneously improving productivity through automated processes, direct communication channels, and reduced manual intervention requirements.
Solution Approach 2:
The patent implements dynamic capabilities that allow the system to adapt to different workflow requirements while maintaining high efficiency. The blockchain network can dynamically adjust to various data sharing scenarios, access permission structures, and transaction types. This dynamic nature enables the system to accommodate existing workflows without sacrificing productivity, as the system can optimize processing paths based on specific claim requirements and organizational preferences.
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.