Relational Databases In Healthcare

Utilizing EDI Database Technologies in Healthcare

What are EDI relational databases in healthcare?

“EDI relational database as a persisted version of the TR3 EDI schema”

Think of an EDI relational database as a persisted version of the TR3 EDI schema. It should be relational in nature and follow similar segments, loops, and data element formats.  It's important to compare EDI solutions and the trick is to find the right mix of normalized relational and flattened structure for fast data throughput. The database should be easy to navigate and understand for an EDI developer or analyst. Otherwise, it would be too labor intensive to understand and work with a data dictionary that has a completely different naming standard and format.

Why are relational databases important for healthcare EDI processing?

“Adding a layer of EDI database in the mix gives healthcare organizations more processing options in the future”

EDI is typically treated as transient, meaning processing only involves picking up from a source location, enriching the message with transformations, and delivering to the destination system. An example of that process may be picking up an 837I (institutional claim) file from a trading partner and sending it to an adjudication system for payment. For EDI processes outside of the healthcare industry, that may be a viable approach. Healthcare EDI data processing typically requires a rich persistence solution that is capable of that same process, plus adding a layer of EDI database in the mix gives healthcare organizations more processing options in the future.

relational databases in healthcare

Parsing to Relational Databases In Healthcare

How are EDI databases used in healthcare?

Healthcare Plans have various compliance considerations when processing healthcare EDI administrative data files such as the EDI 834. Wouldn’t it be nice to be able to store each transaction set at every step for compliance audits, claim and payment correlations, and enrollment file tracking? There are countless other reasons, such as providing data analytics of claims adjudicated or applying data based rules to encounters before sending EDI to the state or CMS for reimbursements.

Healthcare Software Companies may either run EDI data as part of their core business or an EDI database to expand their capabilities. In either case, a robust relational database in healthcare. Top tier EDI software applications leverage healthcare relational databases to is to process, track, provide insights, and ultimately increase revenue with a differentiating solution built on EDI data. EDI data is complex and it’s difficult to store mass amounts of data, especially data for healthcare. An 837I (institutional claim) or 837P (professional claim) can have vast amount of segments, loops, and data elements. Capturing the complete data set from those EDI files can be a daunting task, especially with high volume.

Relational databases in healthcare using ETL

“Healthcare companies can easily create ETL processes and move the EDI data into their business system or proprietary database”

Staging tables implemented as a relational database in healthcare can provide the landing pad for other software solutions or an operational data store (ODS). Staging tables can provide the basis to Enrich, Transform, Load (ETL) to existing in-house data systems. Once EDI is parsed and stored into a relational database, healthcare companies can easily create ETL processes and move the EDI data into their business system or proprietary database.

ETL from Healthcare Relational Databases

Already have a relational database for EDI?

It’s possible to write your own Data Access Layer (DAL) for your existing databases with the right EDI parsing technology. Our T-Connect SDK for developers have built-in hooks to build your custom DAL from a C# .NET object. Out-of-the-box, T-Connect stores data into a SQL Server database and includes all of the data tables, procedures, and views necessary to store EDI, but you can write your own data interface into an existing database system.

Helathcare EDI database optimization

T-Connect's relational databases for EDI

Caliber Health’s EDI software database solution, T-Connect, is designed to quickly  Parse EDI and store high volumes of EDI transactions. It can process inbound EDI files as well as outbounding data from the tables to produce an EDI file. This is a powerful and easy solution that provides tracking, storing, and persisting of EDI ANSI files. The table and field names align well with the TR3 EDI schema formats. This makes it easy for EDI developers and analysts to quickly understand and work with the EDI records. The T-Connect Database plus SDK can be used as a staging table for ETL or operational data needs. It has all of the views, queries, procedures, and documentation pre-built and can be installed and operational in less than one day. It’s also a complete EDI solution, meaning it has services that can automate polling file directories, parse, validate EDI, and store in the database with a simple configuration.

Reports, Dashboards, Analytics

Being EDI capable to process  healthcare EDI data transactions is the centerpiece for reports, dashboards, and analytics. Data can be extracted into a data cube, data lake, or operational data store (ODS). From there, relational databases in healthcare becomes a rich persisted hub for reports and analytics. Healthcare companies can take this one step further and start to correlate different transaction sets into reports such as 835 and 837s.

Improved EDI Reporting with Relational Database

Building a Databasse vs. Buying a Relational Database for Healthcare

Consider the following:

  • Healthcare EDI files are very complex and requires EDI domain expertise as well as EDI developers.
  • Testing is often overlooked and can take just as long as the development stage. Ensure that you verify that each 5010 HIPAA X12 transaction set validates and stores according the specifications provided by X12.org.
  • Compliance is often overlooked. HIPAA X12 5010 transaction sets should follow the schemas published by WPC (from X12.org) to adhere to their published standards.
  • It starts with a valid EDI file that is parsed and passes WEDI SNIP level edits 1 and 2. Once the parsing is validated according the standard, the database’s job becomes better equipped to store and deliver data.
  • Requirements, development, quality assurance, and project management can get into 1,000’s of hours at this scale.
  • Performance is often overlooked. Creating a relational structure takes the right mix of normalized and a flattened structure.
  • It should be Developer friendly. Complex and countless joins, database naming standards, and ETL can quickly drain your budget after the implementation.

Caliber Health’s T-Connect Database Plus SDK Solution

We have spent thousands of hours and developing the proven T-Connect Database Plus SDK solution with many customers to ensure your EDI data transaction persistence needs are considered. Performance, ease-of-use, fast time-to-market (less than a day), and supports all HIPAA transaction sets are a significant value proposition for purchasing a solution versus building a one-off custom one.