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April 15, 2021

CMS Interoperability and Synthetic Datasets

Events
Alette Brinth
&

When the CMS announced their interoperability ruling in 2019, payers came up against the challenge of how to make their member data interoperable and securely exchanged. In response Humana created the HDX (Humana Data Exchange), an API marketplace and synthetic data asset to serve as a centralized data interoperability and innovation hub. In addition to meeting the CMS compliance requirements, the HDX makes data interoperable for developers and end consumers. 

 

For years, the healthcare industry has been ripe with discussion about how healthcare consumers can be empowered to manage their own data. Earlier this year we started working with Humana to explore what it means for the end-consumer to have power over their own data and what it means for developers to have access to synthetic member datasets - here goes….

 

What is in the HDX?  The HDX is an end-to-end solution that contains two things: an API marketplace and a synthetic data Innovation Sandbox. The API marketplace gives members and developers access to APIs/FHIR standards for simplified data exchange, while the Innovation sandbox provides engineers/data-scientists access to synthetic data to test and learn in a secure environment.

 

What is in the API marketplace? There are 9 FHIR APIs currently available in the API marketplace, created through an iterative development process. The APIs cover the key categories including patient demographics, claims history, insurance/coverage information as well as a host of clinical assets, history of conditions and medications. 

 

What is the synthetic data environment? At a high level, this is a synthetic dataset of 500,000 lives broadly bucketed into demographics/coverage details, medical claims (providers/sites of care/diagnosis and procedure codes), pharmacy claims and lab tests/corresponding results. The synthetic data is completely anonymous but fully representative of a real data set. 

 

Why was the HDX created? In a nutshell, the HDX was created to give end-consumers (Humana members) power over their own healthcare data in a centralized location, making sure the data is accessible to be used by each member as, when and how they want.

 

How does the HDX benefit Humana members? For members, the APIs enable them to control their data and share it with any application that has connected with their portal to achieve their best health through seamless data exchange. The FHIR APIs will help Humana plan members understand which providers are in-network and what is covered by their plan.  

 

How does the HDX benefit developers? For developers the HDX is a fast track way to engage with Humana data in an easy, secure manner before establishing any formal partnerships. 

 

The healthcare industry needs to be able to access and analyze data to achieve better patient engagement, improve the patient journey and give stakeholders access to information in real time for better health outcomes. 

 

The HDX sets a new bar for data access and interoperability and can be accessed HERE.

 

For more on the topic our recent blog explores how data can be used to best serve patients and drive innovative outcomes. 

 

Anything you need to know? We’d love to hear from you

 

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