Category: Uncategorized

The Challenge

The US-based patientcare company specializes in delivering in-home personal care to a vast network of 75,000 active patients. A critical challenge they faced was ensuring timely outreach to patients within 48 hours of hospital discharge. However, the obstacle lay in the non-uniformity of Admission, Discharge, and Transfer (ADT) data formats provided by various Health Information Exchanges (HIEs).

Each HIE operated with its unique data cadence (event-driven, hourly, or daily), transmission mode (email or FTP), and data format (XML, CSV, JSON, semi-structured text, RTF, HL7). Effectively processing such a diverse range of ADT data formats in near real-time was a formidable challenge.

The Solution

To address this challenge, a comprehensive solution was implemented. The key approach was to frequently poll various data sources for new ADT data. As all ADT data needed to be integrated into Salesforce Health Cloud, a common JSON structure was created to serve as a standard message format within Azure Service Bus. Upon message arrival, parallel insertion into Salesforce Health Cloud as encounter records was triggered.

Azure Function apps were developed to fetch and parse emails into the common JSON structure, with some mailboxes requiring client SSL certificates for authorization. Additional Azure Function apps were designed to parse HL7 messages using the HAPI HL7v2 Java library. For XML and CSV format messages, Azure Data Factory pipelines were established for efficient processing. HIEs that provided Continuity of Care (CoC) documents in RTF format had their data transformed into PDFs using Azure Logic Apps through Microsoft OneDrive. These PDFs proved valuable for reference by the care team during patient interactions.

The Result

The implementation of this solution significantly improved the patientcare company’s ability to provide quick and accurate services to their patients. With the ability to process diverse ADT data formats efficiently, the care team could promptly reach out to patients, ensuring assessment and medicine reconciliation within the crucial 48-hour window. This transformation not only enhanced patient care but also streamlined operations, reinforcing the company’s commitment to delivering exceptional healthcare services.

This client success story highlights how the US-based patientcare company overcame the challenge of non-uniform ADT data formats, ultimately enabling them to provide quicker and more effective care to their patients.

Tools and Platforms Used

The Challenge

The leading healthcare company faced a significant challenge in their revenue cycle management. They needed to file claims to Payers for the healthcare services they provided. However, the complex process involved various data-dependent factors such as care coordination activities, patient eligibility, ICD-10 codes, supervising providers, CPT codes, modifiers, and units. This intricate process often resulted in filtered-out activities or patients, leading to a decreased number of filed claims and revenue loss.

The Solution

FulzTech implemented a multi-pronged solution to address this challenge. We introduced an approach where raw data was provided to the revenue cycle manager for finalization before bulk claim automation. If the target counts were not met, the missing and causal data points were identified and presented in email notifications along with their root causes.

An Azure Data Factory pipeline was established to generate raw data and send email notifications regarding missing causal data. The initial run was scheduled for the 1st of every month, with subsequent runs being manual but manageable by the revenue cycle manager. Once the data was finalized, the revenue cycle manager triggered an Azure Logic App workflow that filed claims in bulk.

The pipeline meticulously checked various factors, including patient eligibility, active care plans, availability of ICD-10 codes, compatibility of CPT codes with modifiers, and adherence to unit thresholds. Any missing or inadequate data points would result in the filtering of activities or patients. The unit calculation logic was implemented through an Azure SQL stored procedure, while the necessary data extraction programs were developed using Azure Logic Apps.

The Result

Thanks to FulzTech’s solution, the revenue cycle manager could proactively address missing causal data points received in email notifications at every stage. With full control over the entire process, the manager significantly improved claims filing yield, effectively preventing revenue loss. This successful partnership between FulzTech and the leading healthcare customer not only optimized their revenue cycle but also ensured they met their financial targets consistently.

This client success story showcases how FulzTech’s innovative approach in data management and automation transformed the revenue cycle for a leading healthcare company, leading to improved financial outcomes.

Tools and Platforms Used

The Challenge

The US-based healthcare company recognized the need to optimize the efficiency of their panel providers by providing them with updated and accurate patient histories before the start of each visit or encounter. Providers desired access to detailed patient information, including medication history, diagnoses, procedures, lab results, chronic problems, and more, to enhance the quality of care. However, obtaining this information proved to be a substantial challenge. Patients often struggled to recall specific details, such as medication names or lab results, leading to time-consuming efforts by providers to compile accurate histories.

The Solution

To address this challenge and empower providers with timely and comprehensive patient histories, an innovative automation solution was developed:

Automated Patient History Reports: An automation program was implemented to generate historical data reports for patients scheduled for appointments within the next 5 days. These reports leveraged the patient’s last 3 years of claims data, obtained from Payers. The reports featured anti-chronological details of medications, diagnoses, procedures, lab results, chronic problems, and more.

Power BI Report Builder: The historical reports were meticulously crafted using Power BI Report Builder, ensuring pixel-perfect, printable PDFs. If no new claim data was available for a patient, a PDF report was not generated, even if the patient had an appointment within the next 5 days.

Seamless Integration: The automation program seamlessly integrated with Power BI REST API to export the history PDFs, which were then uploaded to the patient’s card in Athena Health, a healthcare management system. The automation program ran hourly, ensuring that patient history was available on the AthenaNet portal for appointments scheduled within the next 2 hours.

Security and Data Access: Authentication and authorization for running the Power BI REST API to export the history PDFs were managed through Azure Active Directory and App Registration. Only authorized applications with the appropriate secret credentials could export the PDFs. Additionally, sensitive credentials required to access claims data from the database and Athena Health were securely stored in Azure Key Vault.

The Result

The implementation of this innovative solution yielded remarkable results. Providers now had access to accurate, up-to-date, and detailed patient histories before each visit or encounter. This not only saved a significant amount of time for the providers but also enhanced the efficiency of care specialists. Patients benefited from improved care quality, as providers were armed with the knowledge they needed to deliver more effective and personalized healthcare services.

This client success story illustrates how the US-based healthcare company streamlined access to patient histories, providing substantial time savings for providers and care specialists, ultimately leading to enhanced patient care and satisfaction.

Tools and Platforms Used