In today’s data-driven healthcare landscape, delivering higher quality outcomes increasingly depends on how seamlessly and securely health information flows — not just from providers to payers, but across every touchpoint in the care journey. When data is shared bidirectionally and in near real-time, consumers are more likely to experience fewer duplicative tests, timelier care, and a more connected healthcare experience.
Making this data exchange actionable and consumer-centered isn’t just a regulatory requirement. It’s essential to building trust, improving transparency, and ensuring people receive the right care at the right time.
When a care provider has a more holistic view of a patient’s health, they can deliver more proactive, high-quality care. When data is effectively and appropriately shared, payers are able to connect providers and consumers in novel ways to help address gaps in care. Patients who view a more complete health history – from their primary care provider, specialist, payer, and other sources – in one place are better equipped to make more informed healthcare decisions.
Why Secure Bi-Directional Exchange Matters
The healthcare system has long been burdened by disconnected data, outdated information-sharing processes, and fragmented communication. Historically, it could take weeks or even months for a payer to receive notification of an event like an ER visit. Providers would waste precious time toggling between systems to gather data that turned out to be incomplete, while patients would endure redundant outreach and disjointed care plans.
Bi-directional data exchange, done securely and at scale, can be achieved through interoperability data platforms, such as Elevance Health and Carelon’s Health OS. These platforms can:
- Empower care providers to make more informed decisions at the point of care through near real-time, data-driven insights.
- Make connected care more of a reality through feedback loops between care providers, payers, and other parts of healthcare where data about episodes of care, labs, medications, or care gaps are sent and received.
- Promote precision engagement between patients and their care team that reduces guesswork and duplication by delivering the right information to the right person at the right time.
Improving Experiences for Providers and Members
Secure, bi-directional data exchange can create a positive ripple effect across the healthcare experience by connecting a diverse array of data types such as clinical notes; lab results; admissions, discharge, and transfer information; and social drivers of health by integrating information from electronic medical records (EMRs), health information exchanges, and other sources.
For Providers:
- Reduced Administrative Burden: Care providers today spend nearly half their time on administrative tasks—often toggling between portals to track care gaps and other important points of care for their patients. By integrating payer data directly into clinical workflows through secure, bi-directional exchange, this burden is significantly reduced. Real-time insights—such as eligibility, care gaps, and authorization status—can be accessed within the EHR, streamlining decision-making and enabling clinicians to spend more time with their patients.
- Quicker Decision Making: Using EMR-integrated data sharing, prior authorization requests can be initiated and with real-time clinical documentation exchange. This can reduce delays and enable more immediate care delivery.
- Improved Clinical Decision Support: Care providers can act in a timelier manner because they have access to a more complete picture of a patient’s history, including recent discharges, lab results, or behavioral health interactions. Having more holistic data at their fingertips can also help them make better-informed decisions and avoid duplicative testing or gaps in treatment.
For Consumers:
- Easier Access to Their Information: Consumers are better able to make more informed healthcare decisions because they have secure and more convenient access to their health information in one place.
- More Coordinated Care: Consumers are more likely to experience connected healthcare because their care team can receive near real-time alerts when their patient has a significant medical event, like going to the emergency room. This rapid visibility enables timely follow-up, reduced readmissions, and improved health outcomes.
- Less Redundancy and Confusion: Consumers are less likely to receive irrelevant appointment reminders or duplicative communications because their care team and health plan are instantly informed of clinical activity and other important health information.
Enabling the Next Generation of Health Intelligence
As the interoperability data platforms mature, the healthcare industry will be able to apply advanced digital technologies to further streamline and strengthen the data exchange process:
- Digital technologies convert unstructured medical records into usable formats through natural language processing, allowing for more actionable insights sooner.
- Real-time metadata extraction makes critical data-driven insights instantly available so care teams have more information as they work with their patients on enhancing their healthcare.
- Predictive analytics and large language models are being used to generate clinical insights that flow back through bi-directional channels to help inform care – such as predict disease progress or identify early interventions.
Building a Safer, Smarter Healthcare Ecosystem
Bi-directional exchange is an imperative. It is the connective tissue of modern healthcare. It bridges gaps between people, systems, and organizations, allowing everyone involved in care to operate from a common, accurate, and actionable understanding of the patient.
Consumers will see more of their routine health needs met as care providers and payers work together to close care gaps. With timely access to the right information, both can make faster, more informed decisions when evaluating treatment options.
In the journey toward a smarter, more connected future, secure bi-directional exchange isn’t just a tool – it’s the foundation.
Ashok Chennuru currently serves as the Chief Data & Digital AI Transformation Officer at Elevance Health
