A Tailored Solution for Startup Practices: Harnessing ZapEHR and HEDIS Data Collection

HEDIS (Healthcare Effectiveness Data and Information Set) is a set of measures that evaluates care quality and efficiency across six domains, impacting over 200 million people who are members of insurance plans required to report quality data. The National Committee for Quality Assurance (NCQA) sets the criteria for HEDIS, which assesses the provision and impact of care, disease prevention, and management. HEDIS reporting is essential for health plans to maintain accreditation and regulatory compliance, affecting both commercial and Medicare/Medicaid plans.

Headless EHR technology is making a significant impact in the healthcare information technology sector, including HEDIS reporting. Startups like ZapEHR offer developers infrastructure and APIs to build advanced EHR solutions. ZapEHR's programmable features enable the ingestion and storage of HEDIS data, allowing for synthesis into measured performance calculations. It can map data elements into FHIR-compliant resources and accept data from multiple sources, streamlining the process and ensuring data portability across systems. By directly feeding visit and claim data into a FHIR data store, ZapEHR eliminates the need for file movement through SFTPs or portals. Its API also connects to health information exchanges (HIEs) for access to relevant data across the care spectrum.

HEDIS measurements cover six domains of care, including effectiveness, access/availability, experience, utilization, health plan information, and measures reported using electronic clinical data systems. Data for HEDIS reporting is collected through surveys, administrative data, and hybrid data combining claims with actual medical records. ZapEHR's headless nature allows for customization and flexibility, enabling the management of multiple API connections and automated performance metric reporting for various insurance payers.

Accuracy and compliance in HEDIS reporting are crucial, as errors exceeding a 5% threshold must be reported post-submission by the provider. The responsibility for accuracy lies with the provider, not the insurance plan. While providers focus on determining measure fulfillment for their patient population, health plans calculate performance percentages for their member panels. ZapEHR's headless technology helps providers report quality performance measures to insurance payers by populating its datastore via API connections to HIEs and other data sources.

Overall, ZapEHR offers a comprehensive solution for HEDIS reporting, streamlining data collection, organization, and calculation of performance measures. With its flexible programming capabilities, ZapEHR assists in accurate reporting and ongoing compliance with HEDIS requirements, providing efficient and automated results.

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