EHRS-FM IG

ISO/HL7 10781 - Electronic Health Record System Functional Model, Release 2.1
0.16.0 - CI Build

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Requirements: AS.8.3 Support Integration of Cost/Financial information into Patient Care (Function)

Active as of 2024-08-12
Statement N:

Support interactions with other systems, applications, and modules to enable the use of cost management information required to guide users and workflows.

 Description I:

The provider is alerted or presented with the most cost-effective services, referrals, devices, etc., to recommend to the patient. This may be tailored to the patient's health insurance/plan coverage rules. Medications may be presented in order of cost, or the cost of specific interventions may be presented at the time of ordering.

 Criteria N:
AS.8.3#01 MAY

The system MAY provide the ability to extract formularies, preferred providers, and other information, from internal or external sources, that are associated with a patient's health care plan and coverage so that the provider can offer cost effective alternatives to patients.
AS.8.3#02 MAY

The system MAY provide the ability to extract information about exemptions on coverage limitations and guidelines.
AS.8.3#03 MAY

The system MAY provide the ability to capture or transmit the request for information about exemptions on coverage limitations and guidelines.
AS.8.3#04 MAY

The system MAY provide the ability to render expected patient out-of- pocket cost information for medications, diagnostic testing, and procedures, from internal or external sources, that are associated with a patients health care plan and coverage.
AS.8.3#05 MAY

The system MAY provide the ability to render a notification of an alert to the provider of care where formularies, preferred provider and other information indicate the health plan requires an alternative.
AS.8.3#06 SHOULD

The system SHOULD conform to function [[AS.9.3]] (Support Service Authorizations) to integrate support of prior authorization processes.