EDI: Standard Format for Inter-Organizational Data Exchange

Electronic Data Interchange (EDI) is the exchange data in an organization using a standard format (Blumenthal, & Tavenner, 2010). Electronic Data Interchange allows intercompany communication of business documents using a standard form. EDI transactions are defined by message standards and are therefore essential to have governance policies to enhance data quality. For instance, when information is missing or is in the wrong place, the EDI documents are likely not to be processed correctly. The paper focuses on educating new employees about EDI in a doctor's office. Also, the paper explains how EDI facilitates electronic transactions as well as describing how healthcare information is shared in EDI. Moreover, the paper describes the relationship between Electronic Health Records, EDI transactions, HIPAA, and reimbursement.

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Using EDI facilitates electronic transactions in various ways, such as improving relationships with an organization. Data is first captured using an internal format and later transmitted to the EDI translator and then to an EDI document (Blumenthal, & Tavenner, 2010). EDI facilitates transactions in the health industry in many ways, such as electronic attachments for insurance claims. Also, EDI helps in the transfer of a patient's information and medical history from one department to another. For instance, doctors use EDI to transmit information regarding the prescribed medicines to the healthcare pharmacist. Therefore, EDI helps in facilitating electronic transactions and management of both patient's medical records and insurance reimbursement details. Electronic attachments and documents streamline processes and procedures within healthcare.

Health Insurance Portability and Accountability Act (HIPAA) is legislation in the United States that was passed in 1996 (Blumenthal, & Tavenner, 2010). HIPAA regulates and sets data confidentiality and security regulations that help in safeguarding data such as a patient's records and health identification documents. HIPAA has impacted on how healthcare data is shared in EDI in various ways. For instance, the regulation prevents group health plans from limiting or denying certain insurance coverages. Also, HIPAA allows the department of health in the US the right to establish health care standards when processing electronic transactions. HIPAA has affected how healthcare information is shared in EDI since the regulation sets the security standards that must be put in place that help in protecting health information (Miller, & Sim, 2014). Therefore, HIPAA has affected significantly electronic transactions since the law requires doctors and other health professionals to handle a patient's information with the utmost confidentiality.

The regulations limit the extent to which health professionals may share data such as disclosure of a patient's illness from one department to another. The privacy rule contained in HIPAA limit how medical professionals apply EDI transactions since it covers the disclosure and use of protected health information as well as standards that should be upheld for patients to control and understand how their individually identifiable health details are used by a healthcare facility (Miller, & Sim, 2014). HIPAA regulations apply to health plans such as health insurance companies and health care providers that include pharmacists, nutritionists, nurses, doctors, sonographers, dentists, and lab technicians. The HIPAA regulations have been impactful on the use of EDI in healthcare facilities. HIPAA impact on the use of electronic transactions in healthcare since doctors and other professionals are limited on the extent to which they can share information of a client.

HIPAA regulations provide crucial elements of an individual who is covered, the kind of information that is included, as well as how protected health information can be disclosed or used (Blumenthal, & Tavenner, 2010). Sharing of information within the healthcare industry is affected by HIPAA regulations since they cover health care clearinghouses that process nonstandard data which they receive from other institutions. Healthcare clearinghouses receive individually identifiable health data to health plans, business associate, or healthcare professionals (Iakovidis, 2010). However, HIPAA regulations limit the extent to which clearinghouses may share an individual's information to a third party such as doctors and vice versa (Miller, & Sim, 2014). Some of the information that is protected by HIPAA regulations includes demographic data such as a person's past, present or future mental or physical conditions. Also, HIPAA protects the past, future, or future payments for the provision of healthcare services to an individual and thus affect how information is shared on electronic data interchange systems (Iakovidis, 2010).

There exists a relationship between electronic health records, reimbursement, HIPAA, and Electronic data interchange transactions in various ways. Electronic health records include the medical history of a patient maintained in an electronic form. Electronic health records are transmitted from one department to another within a particular health care facility (Miller & Sim, 2014). Electronic health records that are transferred using EDI are preferred since they reduce the incidences of medical error as well as improve the accuracy of medical records. Reimbursement refers to the compensation of money spent in health care facilities by insurance companies and therefore has a relationship with HIPAA since the regulations control on the kind of data that can be shared to hospitals. Therefore, there exists a relationship between EDI, HIPAA, reimbursement, and electronic health records.

References

Blumenthal, D., & Tavenner, M. (2010). The "meaningful use" regulation for electronic health records. New England Journal of Medicine, 363(6), 501-504. Retrieved from

https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=electronic+health+records&btnG=#d=gs_cit&u=%2Fscholar%3Fq%3Dinfo%3AVKrnr5IENPwJ%3Ascholar.google.com%2F%26output%3Dcite%26scirp%3D0%26hl%3Den

Miller, R. H., & Sim, I. (2014). Physicians' use of electronic medical records: barriers and solutions. Health Affairs, 23(2), 116-126. Retrieved from

https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=electronic+health+records&btnG=#d=gs_cit&u=%2Fscholar%3Fq%3Dinfo%3AVKrnr5IENPwJ%3Ascholar.google.com%2F%26output%3Dcite%26scirp%3D0%26hl%3Den

Iakovidis, I. (2010). Towards personal health record: current situation, obstacles, and trends in implementation of electronic healthcare record in Europe. International journal of medical informatics, 52(1-3), 105-115. Retrieved from

https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=electronic+health+records&btnG=#d=gs_cit&u=%2Fscholar%3Fq%3Dinfo%3AVKrnr5IENPwJ%3Ascholar.google.com%2F%26output%3Dcite%26scirp%3D0%26hl%3Den