Suncoast RHIO
Fail-Safe Health Information Exchange

In the fast-paced healthcare ecosystem, sharing patient information trapped within paper charts and disparate electronic systems across multiple organizations is an intrinsic requirement. The surge in medical errors, duplication of reports, inability to trace patient information and growing concerns about the economic viability of government programs such as Medicare and the Social Security Trust Fund mandates a better and more ubiquitous health information technology, one that adheres to data sharing and secure standards.

SunCoast RHIO is on a mission to enable this with robust solutions aimed at streamlining health data exchange. The company’s goal is to get the word out to hospital CIO’s and purchasing managers about their position in this space, so they can put SunCoast RHIO on their approved vendor list and sleep better at night. The company’s client base extends to 100 hospitals across the US and had reported quality measures for over 15,000 individual providers or provider groups before COVID first hit.

"We gather across a variety of stakeholders, including providers, payers, laboratories, and public health departments, to streamline health data exchange networks and facilitate the use of information in a secure manner that improves the quality, safety, and efficiency of healthcare delivery,” says Lou Galterio, CEO and founder of SunCoast RHIO.

Its portfolio covers individual products and services, including electronic submission of quality measures (eCQM) and Social Determinants of Health, encrypted messaging and email, electronic response to government audits, and a customized “Population Health” website using Agency for Healthcare Research and Quality (AHRQ) tools. SunCoast RHIO also offers consulting, training modules and informational blogs to the public and the provider communities.

SunCoast RHIO plays the role of a “hot site” for storing, protecting, and managing information and assets for healthcare providers, mitigating risks during temporary incapacity with their primary, enterprise-sized vendors. Certified government software is exactly the same no matter the vendor or their size. SunCoast RHIO’s software is government approved, qualified, and certified since 2013. They undergo recertification annually and sometimes, as with audits, it is done quarterly. This is where SunCoast’s “Fail- Safe” product stands out. Every member is set up by the company and if their primary vendor fails, members can switch over to SunCoast RHIO within minutes without impacting their operations, until the vendor issue is resolved.

"If you think you're covered just because you have an enterprise-sized vendor, you may be rolling the dice with your charge as your company's IT assets fiduciary," says Galterio. "A small breakdown at a large vendor can lead to a cascade contagion event for many services and clients and, of course other 3rd parties."

Here, Galterio’s disaster recovery experience in the banking sector and his expertise in government systems have helped SunCoast establish itself for this fail-safe option for healthcare providers. Its managed backup and interoperability services can be subscribed to by providers for a standard membership fee. Members of Suncoast RHIO, such as Sarasota Memorial Hospital and Desoto Memorial automatically have this service enabled as part of their benefit.

"Our membership guarantees the convenience and assurance of data safety. It also helps providers with audit submissions and prior authorization in claims processing," says Galterio.

"All Things Electronic," with the Fail- Safe Product Line

SunCoast RHIO eliminates gaps within patient data to help maximize reimbursements and improve MIPS scoring. It identifies and addresses these gaps using the most up-to-date reporting requirements for streamlined hospital Value Based Purchasing (VBP) and MIPS submission; assisting providers in avoiding penalties; improving performance scores; and succeeding with EHR Incentive Programs and the Quality Payment Program (QPP).

This, and secure electronic auditing and prior authorization services, constitute SunCoast’s risk-averse “Fail-Safe” program with an up-and-coming blockchain ransomware prevention program.

In another category, Prior Authorization, a treatment that needs authorization from the payer is a huge administrative burden on the care provider, the payer, and the patient. Patients may have to wait days, weeks, or months in appeals while physicians follow up with the insurer to obtain authorization. SunCoast RHIO working with PHICURE software from Imagine Software, can pull out the required information, package it for providers, and send it to the payer. It reduces claim delays and helps generate more clean claims.

“For prior authorization, we can reduce decisions from weeks to days and perform the activities needed under the soon-to-announced CMS Prior Authorization FHIR rules,” says Galterio.

Similarly, SunCoast's platform can streamline various data feeds to report audit evidence to the government in a secure esMD (Electronic Submission of Medical Documentation) format approved by CMS. It covers RAC and RC responses with additional documentation requests, appeals, pre-authorization, and pre-claims submission for all taxonomies and SunCoast will send the notification letters electronically. The company is starting to see these audits for Medicare Advantage plans as well as plans in the Health Marketplace. Interoperability is a big thing today in health IT which is why SunCoast RHIO utilize the Digital HIE (Health Information Exchange) with InteropX for its FHIR protocols.

We View Security, Compliance, And Policies And Procedures As Inherent Components Within Our Interoperable Processes And The Interacting Mechanical Perfection Of Every Transaction. This Helps Our Clients Trust Us With The Ever-Changing Key Regulations And Industry-Defined Standards

SunCoast is one of 15 companies in the country authorized to electronically submit responses to auditors. It also provides audit notifications to providers through a HIPAA-compliant, encrypted email system. The electronic audit response and notification service is easy to engage when needed in an emergency, with little setup.

“A preparedness premium for readiness averts major losses by not having to pay back past claims within the short 30-to- 45-day window given for audit responses,” Galterio says.

“We Like To Call Ourselves A ‘Logistics’ Company That Captures, Packages, And Distributes Medical Information To The Right Destination, Untouched And Unaltered. We Are Experts At Moving, Finding, And Displaying Trusted Data”

To further complement its “Fail-Safe” program, SunCoast RHIO's comprehensive product line includes EHR quality reporting (as a CMS-qualified MIPS registry), Direct Secure Messaging, and Health Information Exchange.

An Electronic "Logistics” Company for Healthcare Information

SunCoast RHIO provides cross-functionality through its certified software, which includes compliance built into all transactions across every geography and client type. SunCoast’s OpenEMR and “Direct Secure Messaging” DSM options is one of the few open-source alternatives to proprietary patient record systems that offers records in a format that is more transferable across software systems. A primary care physician, for instance, can use its platform to securely share a patient's medical history, test results, and other health information with a provider or payer, who can then use that information to make informed decisions for the patient's care or for processing claims.

“We like to call ourselves a ‘logistics’ company that captures, packages, and distributes medical information to the right destination, untouched and unaltered. We are experts at moving, finding, and displaying trusted data,” says Galterio. There are big questions for healthcare technology in 2023 and SunCoast RHIO addresses the issues facing hospital and provider technologies and map them to solutions.

Some HIEs only hold data. Others only move it. SunCoast RHIO does both.

When exchanging data, healthcare providers also need to show that their certified EHR technology meets CMS-approved measurement thresholds that range from recording structured patient information to exchanging summary of care records for QPP and EHR incentive payments, including Medicare and Medicaid. SunCoast helps them easily achieve this.

“We view security, compliance, and policies and procedures as inherent components within our interoperable processes and the interacting mechanical perfection of every transaction which includes attention to 3rd party risk. This helps our clients trust us with the ever-changing key regulations and industry-defined standards,” says Galterio. By working with SunCoast’s Security Official Johan Lidros with the Eminere Group—in combination with CORLTech.com (who SunCoast RHIO is in discussions with to manage 3rd party risk)—the company will have covered many of the risk gap areas that they supplement with their award-winning and AHIMA and Iron Mountain acknowledged policies and procedure system.

In addition to improving patient care, SunCoast RHIO's capabilities reduce provider and insurer expenses associated with duplicate tests, time involved in recovering missing patient information, and error-prone manual processes associated with traditional communication channels.

Remaining Relevant for the Future

SunCoast RHIO’s services are tailored to meet the specific needs of a rich mix of participants, covering populations across rural and metropolitan areas. All taxonomies, including family medicine, acute and long-term care, as well as the specialties within them, are covered.

In one instance, SunCoast RHIO was approached by a cardiovascular ACO that suffered significant penalties due to poor quality reporting. SunCoast RHIO was able to reverse engineer the process used by the ACO's previous vendor. It converted the information to electronic health record fields in the Consolidated Clinical Document Architecture (CCDA) and the Quality Reporting Document Architecture (QRDA) and Data Exchange for Quality Measures Implementation Guide for Fast Healthcare Interoperability Resources (FHIR). As a result, CMS allowed the ACO to resubmit the reports, saving the organization over $2 million.

SunCoast RHIO relied on word-of-mouth marketing until now and it fostered affiliate and operating subsidiary relationships with a list of partners, including Phicure, DigitalHIE.com, Kno2, Unit Ventures (for Blockchain Tokenization), and InteropX.

It is currently evaluating franchise-like rollouts that cater to different geographies and demographics, as well as spinning off local RHIOs, using its centralized certified programs as a hub. It has already created the first test model, “The Health Hub,” based in New York City.

SunCoast RHIO is looking toward exploring blockchain technology and has trademarked “The Healthcare Blockchain,” and secured a provisional patent combining hardware, firmware, and software. It applies the no double-spending principle of Bitcoin to achieve “no double-patient” and “no double (or incorrect) care.” Through the Blockchain ledger, the company hopes to make the patient the miner so that Proof of Patient (PoP), much like the Proof of Work (PoW), includes validation by the patient, pharmacy, provider, and payer.

It generates “Utility” tokens (a token is just an abstract representation of something else that is real), and each is backed in reserve by physical Diamond Standard Coins (DiamondStandard.co) and Goldback units from United Precious Metals Association (UPMA.Org) and Bitcarbon Diamond blockchain tokens. It will also act as a robust ransomware firewall by allowing the fast rebuilding of hostage files and data under any other vendor's certified EHR. The patient record is in the ledger.

“My vision is its operationalization by optimizing the granularity in all of the cohorts of the global health record metadata. With the data coming together in a ledger-like form where every part, including API’s, are validated, normalized, and auditable, we can ensure that it provides the correct data about the right person at the right time to the rightly authorized people,” says Galterio.