Imagine you are the office manager at a small doctor’s office. As the office manager, you are in charge of educating new employees.
Write a 700- to 1,050-word reference guide describing electronic data interchange (EDI).
Your reference guide should:
Define EDI.
Explain how using EDI facilitates electronic transactions.
Explain how HIPAA has changed how health care information is transmitted in EDI.
Describe the relationship between Electronic Health Records, reimbursement, HIPAA, and EDI transactions.
Cite a minimum of two outside sources according to APA guidelines. For additional information on how to properly cite your sources, access the Reference and Citation Generator in the Center for Writing Excellence.
Format your assignment according to APA guidelines.
Answers
Electronic Data Interchange (EDI) Reference Guide
Technology in healthcare has increased in the recent past and changed the way providers relate with their patients. Health information technology is meant to improve the quality of care and reduce the cost paid by patients and their insurance providers. At the same time, IT is aimed at strengthening reimbursement to ensure that provides receive their due payment after delivering care to patients. Although numerous concepts relating to technology have emerged in the wake of the health information system, Electronic Data Interchange (EDI) is one of the most important due to its support for electronic transactions, implications associated with HIPAA, Electronic Health Records, and reimbursement.
EDI Definition
Electronic Data Interchange refers to the electronic transfer or transmission of data between different computers. The tool is the standard that the Health Insurance Portability and Accountability Act of 1996 designates for the exchange of patient information in health care facilities, including doctor’s clinics. Electronic Data Interchange systems reduce the use of paper-based records, which require printing, storage, posting, and retrieval. Consequently, records are efficiently and cost-effectively managed using the electronics system (Malhotra & Lassiter, 2014). Information management in the future of healthcare moves closer to the complete elimination of paper-based records when providers use systems, such as Electronic Data Interchange, in providing faster and better care to patients. The conversation of records to electronic formats has proven beneficial to doctors due to the improved management and cost implications.
How EDI Facilitates Electronic Transactions
Electronic Data Interchange involves different levels of electronic transactions in healthcare settings. EDI provides an effective process to support the electronic transfer of data from one computer system to another. For example, an EDI folder could move from the consultation point to the Accounts departments for processing. EDI supports the transaction by preventing the use of paper records between the two departments. The system supports electronic transactions by creating a link of communications between departments and even firms, such as from the doctor’s office and the insurance provider. The system ensures the integrity of data moving from one location to another, improve communication between stakeholders in the care process, and support the quality of care (Malhotra & Lassiter, 2014). The system also helps to verify information easily by tracking the movement from one point to another. For example, the insurance provider can quickly check information provided in the doctor’s clinic to ensure that it is correct and valid to make reimbursement. Thus, EDI is a critical system to support electronic transactions in the health care delivery process.
How HIPAA has Changed how Health Care Information is Transmitted in EDI
HIPAA has significant implications in the transmission of health care information in EDI. The Health Insurance Portability and Accountability Act (HIPAA) sets the standards for the creation and use of electronic records in healthcare. The Act was intended to increase the efficacy of the healthcare system in the country by improving the quality of care provided through the use of electronic records. The use of the EDI system in healthcare relates to the goal of HIPAA related to health care information transfer (Lee et al., 2015). Therefore, the legal code sets out the mechanisms and regulations for the use of EDI transactions. Furthermore, the law has created new demands for the transfer of electronic information and EDI transactions, such as the need to ensure the privacy of patient data.
The Relationship between Electronic Health Records, Reimbursement, HIPAA, and EDI Transactions
Electronic records have become a norm in health care settings, as many facilities embrace the use of information systems to collect and manage patient information. Hospitals keep the electronic version of a medical chart, which they transmit electronically through EDI. The systems make the information available in real-time for different purposes, including reimbursement. Health care organizations create Electronic Health Records, which includes records of treatment, including any prescriptions. HIPAA necessitates the creation and use of Electronic Health Records, such as EDI claim transactions. The hospital can transmit the record (such as a bill) through the email to the insurance provider for reimbursement. When the EDI claim transactions emerge under the HIPAA regulation, the hospital fills in a claim to the insurance provider through an electronic claim submission (Kings, Nelson, & Allergan Inc, 2014). The process is easy and fast, as well as capable of verifying information to ensure that all claims are valid and reimbursed efficiently.
Conclusion
Electronic Data Interchange is one of the significant changes in the healthcare system and involves the use of electronic medical records to support the quality of care outcomes. The system involves the transfer and movement of electronic information from one place to another, such as from the hospital to the insurance provider for reimbursement. HIPAA, which is the legislation in the US, involved with the creation and use of electronic records, supports the use of EDI for various purposes, including reimbursement. Many health care facilities use the EDI system. Furthermore, the future will see an increase in the creation and movement of electronic health records to facilitate quality care outcomes.
References
Kings, R.K., Nelson, K.M., & Allergan Inc, (2014). Method for reimbursement of healthcare services. U.S. Patent Application 14/236,240
Lee, S. L., Ainin, S., Dezdar, S., & Mallasi, H. (2015). Electronic data interchange adoption from technological, organisational and environmental perspectives. International Journal of Business Information Systems, 18(3), 299-320.
Malhotra, N., & Lassiter, M. (2014). The coming age of electronic medical records: From paper to electronic. International Journal of Management & Information Systems (IJMIS), 18(2), 117-122.
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