Healthcare providers rely on accurate patient information to manage billing, insurance claims, and regulatory compliance. Legacy HL7 tools, such as Mirth Connect, Corepoint, and Rhapsody, struggled to clean and map inconsistent data from multiple electronic health record (EHR) sources. Decisions was selected to provide a robust HL7 module, combined with a flexible rules engine, enabling automated validation, transformation, and standardization of patient demographics for downstream revenue cycle processes.
Challenge
Prior to Decisions, the company faced:
- Inconsistent or incomplete patient demographic information, leading to claim denials and delayed reimbursements.
- HL7 integration tools that could not scale or apply complex data cleansing rules.
- Manual reconciliation, increasing risk of human error and non-compliance with HIPAA/HITECH requirements.
- Limited audit visibility for tracking changes to protected health information (PHI) and electronic PHI (EPHI).
Solution
Decisions standardized patient demographic information using its HL7 module and data mapping rules. The platform applied configurable validation rules to cleanse incoming ADT messages and ensured alignment with downstream revenue cycle systems. Key features included:
- HL7 Module & Rules Engine: Cleaned and mapped patient demographic data from multiple sources.
- Data Validation & Standardization: Automated rules checked for accuracy and compliance.
- Audit & Compliance Logging: Maintained full records of transformations and updates to PHI/EPHI.