Capitation Lists

Posted by on October 28, 2011 in Health Care, Health Care Interfaces, Interface Standards, Rant | 0 comments

Capitation Lists

Keystone Mercy decided to change the way they electronically give providers their capitation lists now. It’s bad enough that this information should be available at the beginning of the month and usually isn’t until the middle of the month. By changing the format from a CSV file to a PDF, it throws off the automated importing of this list into an EMR that could save time in verifying a patient’s insurance.

This is one HUGE issue in the healthcare world and one reason why everyone’s fantasy of all hospitals, providers, insurance companies, labs, etc, communicating seamlessly with each other will NEVER happen. Standards need to be in place for this kind of thing. If everyone gets used to a CSV file being imported into their system, and then you go and change it to a PDF, not only do you have to convert the PDF into a more computer readable form before importing it, it’s less standardized and takes more time. Plus the developers of every system that uses the file have to spend the time to create a new importing method.

Until standards are created, all these systems are just going to be somewhat connected wherever it’s easiest. The places that do have standards, like HL7 for labs and consultations are a good place to start. These standards are making it easier for everyone to create an interface that will communicate with more than just one other system. These standards have their issues too, especially if the implementer don’t like something in it and doesn’t follow it exactly, but that’s a different story.

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