Strategies for Enhancing Clinical Data Exchange in 2025
Written by: Cheryl Reifsnyder, PhD and Auren Weinberg, MD, MBA, Chief Medical Officer, Veradigm
Quantifying the amount of clinical data exchanged daily in healthcare is impossible. This flow of information is a cornerstone of modern medical practice—partially because coordinating patient care requires seamless information exchange between payers and healthcare providers. Providers require clinical data for making treatment decisions, tracking patient outcomes, and for submitting claims and prior authorization requests to payers. Payers need clinical data to determine medical necessity and evaluate prior authorization requests.
The electronic exchange of data related to patient care (e.g., medical records, encounter notes, or imaging results) is known as clinical data exchange (CDE). CDE’s goal is facilitating access to and retrieval of clinical data to enable the timely delivery of safe, effective, and efficient patient care. CDE is used to share information from provider to provider, provider to payer, and payer to payer.
Traditionally, over 100 million of the medical record requests healthcare providers receive annually are exchanged by manual methods such as mail or analog fax—methods that are costly, time-consuming, and prone to errors. The lack of seamless payer-provider data exchange can negatively impact patient care, worsening outcomes and increasing costs. Although there have been substantial advances in CDE in the past decade, more is sorely needed.
As we enter 2025, integrating advanced technologies and innovative exchange models promises to significantly enhance the benefits healthcare providers, patients, and payers receive from shared health information. Join us in exploring the strategies that will define CDE this year and pave the way to a more connected healthcare ecosystem.
Current CDE landscape
Healthcare interoperability—the ability for different healthcare IT systems to interact—has advanced significantly in the past decade. Most organizations today have an electronic health records (EHR) system. Even those with paper records have largely digitized them, significantly improving data sharing.
CMS Interoperability and Patient Access Final Rule
In 2020, interoperability and CDE benefited greatly from the Centers for Medicare & Medicaid Services (CMS) Interoperability and Patient Access Final Rule, which established policies designed to improve interoperability and encourage CDE. This Final Rule created interoperability standards, a “common language” enabling systems to interact better. It established requirements to prevent “information blocking,” or practices likely to interfere with, prevent, or discourage access to and exchange of electronic health information.
TEFCA
In December 2023, the Office of the National Coordinator for Health Information Technology (ONC) announced that TEFCA (The Trusted Exchange Framework and Common Agreement) and its nationwide health data exchange were operational. TEFCA was first introduced in 2016 in the 21st Century Cures Act, an initiative supporting the bidirectional exchange of health data on a national scale. TEFCA defines legal and technical requirements for secure information exchange and outlines principles to facilitate trust between health information networks.
TEFCA includes several organizations designated as Qualified Health Information Networks (QHINs). QHUINs form TEFCA’s core, responsible for safely and securely routing queries, responses, and messages between participating Health Information Exchanges (HIEs) and their members (i.e., patients, providers, hospitals, health systems, payers, and public health agencies.) QHINs connect directly to one another to facilitate nationwide interoperability; each QHUIN connects participating HIEs, while the HIEs connect individual members.
As the government’s trusted network for health data, TEFCA will be a major driver of the future of healthcare interoperability and CDE.
Regulatory changes
The government has recently passed several regulations to support improved healthcare interoperability. One of these, the CMS Interoperability and Prior Authorization Rule, finalized January 2024, requires impacted payers to implement an HL7® FHIR® (Fast Healthcare Interoperability Resources) Prior Authorization application programming interface (API) to facilitate the payer-provider prior authorization process. APIs facilitating real-time clinical data exchange between patients, providers, and payers will become enforceable in January 2027.
The 21st Century Cures Act (2016) created penalties for individuals, organizations, and other entities that participated in information blocking but did not implement details of those penalties. In 2023, the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) published a final rule implementing penalties of up to 1 million dollars per violationfor information-blocking actors initially identified in the Cures Act, including:
- Health IT developers of certified IT
- Entities offering certified health IT
- Health Information Exchanges (HIEs)
- Health information networks
In a 2024 Final Rule, HHS also established penalties for healthcare providers participating in information blocking.
Barriers to standardized, secure CDE
Despite these and other efforts to promote interoperability and standardized CDE, faxing continues to be the primary means of sharing clinical data, especially for smaller organizations. Improving CDE across healthcare clearly benefits payers, providers, and patients—so what stands in its way?
One key barrier is that provider and payer organizations differ widely in their levels of technology adoption. Many use health information systems installed and set up years or decades earlier. Compliance with data standards and interoperability frameworks is extremely difficult with such legacy systems. CDE implementation in older systems can also be costly; installing newer technology with better interoperability is also costly.
Even among those using electronic data exchange, there has been inconsistent adoption of data standards. As a result, data are often formatted inconsistently, making data extraction difficult. Varying standards are also used for data entry and data exchange; inconsistent standards and data entry practices result in poor data quality.
Yet another critical barrier: Even when organizations invest in CDE technology, users often have varying proficiencies. Some are unskilled with the technology itself; others have inconsistent data entry practices. Either interferes with effective, efficient CDE.
Advanced models for CDE
As the technologies used for CDE advance, it has become essential for medical practice administrators, owners, and IT managers to understand the different HIE models available. Currently, there are 3 primary HIE models, each with distinct approaches to data management, security, and privacy practices, and each with different benefits and challenges:
- Centralized Model
- Federated or decentralized Model
- Hybrid Model
Centralized model
In the centralized HIE model, all patient health information is stored in a single Clinical Data Repository, where all member organizations have uniform access to patient data. The centralized model enables faster, more efficient retrieval of patient data. Centralized data storage makes it easier to implement standardized security measures, which helps ensure patient data are secure and compliant. This model also tends to have clear oversight and governance structures in place, helping ensure proper oversight of data usage.
However, setting up the centralized model requires a significant initial investment in technology and infrastructure. This model can also be prone to data-matching difficulties. This can lead to inaccuracies in patient matching, negatively impacting patient safety. Finally, smooth operation of the centralized model requires member organizations to upload data in a timely manner; delays can lead to inaccuracies in patient information, which can negatively impact patient care.
Federated/decentralized model
In the federated or decentralized HIE model, patient data is stored at each provider’s location. This enables organizations to maintain control of their patients’ data while still participating in a larger-scale data sharing network. Practices using the federated model benefit from reduced upfront implementation costs. Each practice or organization maintains data ownership, increasing data security and facilitating compliance with privacy regulations. The federated model also enables real-time data access: Because patient data remains at its source, providers can access patients’ most current information without dependence on whether another practice has uploaded the most recent data to the central data repository.
One disadvantage of the federated model is the resulting complexity of data exchange. As each practice or organization keeps its patients’ data on-site, data access must be coordinated across multiple locations—creating potential interoperability issues. The federated model also requires a centralized solution that can locate patient records across the various member sources, adding another layer of complexity that can negatively impact the speed and efficiency of data sharing.
Hybrid model
The hybrid HIE model seeks to combine the best aspects of the centralized and federated models while minimizing each model’s weaknesses. This model provides greater flexibility than the others, helping it better meet the needs of individual organizations. Because organizations can choose which data elements to store centrally, they can better balance data control with data accessibility. The hybrid model can also be scaled easily to accommodate additional organizations or practices as needed.
Of course, the hybrid model brings its own challenges. The increased complexities of combining the centralized and federated models increase the associated administrative burden. In addition, its use of multiple data sources may make compliance more difficult due to use of different standards at different locations.
Key role of healthcare data analytics platforms
Whatever model organizations choose for managing CDE, simply communicating patient information is insufficient: Payers and providers require ways to quickly identify quality gaps and evaluate the efficacy and efficiency of potential interventions. Data analytics platforms draw insights from clinical data to guide best actions.
These analyses require streamlined access to patients’ clinical data. This means that payers and providers need a way to exchange patients’ clinical information more quickly, easily, and securely. They need a tool that facilitates information exchange without requiring time-consuming extra steps such as logging into different payer portals for every patient.
Veradigm Payer Insights
Targeted interventions and gap closures are crucial in improving patient care and health outcomes. However, providers are not always aware of existing care gaps for their patients. Veradigm Payer Insights is an innovative new solution, free for providers, that addresses this need.
Veradigm Payer Insights allows payers to access and analyze EHR data to identify and evaluate care gaps. They can then share gap information directly into individual patients’ electronic health records, enabling providers to address those gaps during the patient care workflow—the time when they are most likely to be able to use the information.
Veradigm eChart Integration and Analytics
Veradigm eChart Integration and Analytics is a data exchange solution that facilitates payer-provider collaboration through the automated exchange of patient information. The standard process for chart retrieval may take several months; with eChart Integration and Analytics, chart retrieval generally takes a month or less.
By automating the exchange of medical record information, Veradigm eChart Integration and Analytics helps health plans manage EHR data from multiple sources—increasing efficiency and leading to better care coordination. It uses the current secure, encrypted healthcare data exchange standard, HL7® FHIR®, allowing data to be exchanged seamlessly with all FHIR-compliant EHRs. All patient information is transferred in an encrypted format to ensure data security.
Veradigm eChart Integration and Analytics also works with multiple leading EHR vendors. The solution can manage data from various types of data sets, including both EHRs and HIEs. It aggregates, normalizes, and homogenizes data through a member-matching process to support longitudinal patient records. It transforms clinical data into human-readable and database-ready formats.
The result? Veradigm eChart Integration and Analytics reduces the administrative burden for medical practices, decreases labor costs for payers, and shortens CDE turnaround times for all involved. At the same time, it enables more complete and more effective support for gap closure efforts by integrating data originating from different EHR sources.
Meanwhile, the automated exchange of patient information facilitates payer-provider collaboration and supports providers in making more informed care decisions.
Future of CDE
This is a time of change and chaos for healthcare information exchange. Although the government has begun defining standards and frameworks for healthcare interoperability and technical standards for data storage, exchange, and security, adoption of these standards and frameworks has been inconsistent.
However, effective CDE is essential for a broad range of healthcare processes, from coordinating patient healthcare, addressing care gaps, and improving patient outcomes to improving quality of care and lowering healthcare costs. Most importantly, the more complete a picture we can create of a patient’s overall health, the more effectively and efficiently providers can coordinate and deliver that patient’s care, resulting in improved care quality, patient experience, health outcomes, and healthcare costs.
That’s why we expect the future of CDE will bring changes from multiple directions. Payers, providers, and other healthcare stakeholders cannot afford to wait any longer to work toward improved CDE. Improving CDE means overcoming barriers to standardized, secure exchange of clinical data, and one of the first steps to overcoming these barrier will be gaining widespread adoption of TEFCA and compliance with FHIR and HL7 standards within healthcare.
Currently, the U.S. government has put some penalties in place targeting individuals and organizations failing to implement required interoperability frameworks and data standards; additional penalties or regulations may be imposed if the situation does not improve. However, this is an opportunity for the healthcare industry to stave off further regulation by independently finding efficient, innovative ways to share healthcare data rather than waiting for additional regulatory guidance.
For instance, Veradigm Payer Insights reduces provider abrasion by delivering a free, easy-to-use solution to the known challenge of payer-provider CDE. This solution enables payers to access and analyze EHR data to identify and evaluate care gaps. They can then share care gap information with providers at a time and place where they can best use it within individual patients’ electronic health records during the patient care workflow.
Veradigm eChart Integration and Analytics can also facilitate payer-provider collaboration by automating the exchange of patient information. This solution works directly with multiple leading EHR vendors to assist payers and providers in sharing clinical data more efficiently via a process that unifies and standardizes data from multiple EHR sources into human-readable and analysis-ready formats.
Contact Veradigm to learn how we can help you enhance clinical data exchange in a way that streamlines interactions and prepares data for further analysis.