Master EDI in Healthcare—With Managed SFTP

EDI systems facilitate the streamlined transmission of medical records, billing information, and other essential healthcare communications between institutions. Yet, while EDI enhances operational efficiency, it also brings challenges in maintaining data security and compliance with stringent healthcare regulations.

Managed SFTP provides an encrypted, reliable pathway for transferring sensitive healthcare information, addressing the vulnerabilities inherent in traditional EDI systems. Our Managed SFTP solution, SFTP To Go, significantly enhances the security and performance of existing EDI frameworks. 

By integrating Managed SFTP with their existing or planned EDI systems, healthcare organizations can achieve a higher standard of data protection and compliance, ensuring the confidentiality, integrity, and availability of patient information and other critical healthcare data.

Understanding EDI in healthcare

Electronic Data Interchange (EDI) facilitates rapid and accurate communication between healthcare providers, insurance companies, government agencies, and patients, enhancing the efficiency of healthcare operations and patient care. It does this by ensuring standardized formats for different types of data transactions.

EDI’s implementation in healthcare is governed by strict standards to ensure that all parties have a common language for exchanging data. Among the most utilized standards are the Health Level Seven International (HL7) and the ANSI X12, which cover a wide range of transactions essential to healthcare operations. 

These standards are instrumental in achieving interoperability and ensuring the seamless flow of data across the healthcare system.

Common healthcare EDI transactions include:

• Healthcare claim transactions (EDI 837): Facilitates the submission of healthcare billing claims from providers to payers. It is one of the most critical transactions, enabling the reimbursement process for healthcare services rendered.
• Eligibility inquiry (EDI 270) and response (EDI 271): Allows healthcare providers to inquire about a patient's health insurance coverage with a payer, receiving information on coverage details and benefits eligibility in return.
• Claim status inquiry (EDI 276) and response (EDI 277): Used by providers to check the status of a healthcare claim previously submitted to a payer, helping in tracking the progress of claims processing.
• Payment and remittance advice (EDI 835): Communicates payment information from payers to providers, detailing the adjudication of claims and the breakdown of payments made.
• Enrollment and disenrollment in a health plan (EDI 834): Facilitates the management of health plan subscriptions, including the enrollment, disenrollment, and changes to the enrollees' information.
• Pharmacy claim transaction (EDI 837P): Similar to the healthcare claim transaction but specifically for pharmacy claims, facilitating the submission of prescription medication claims to payers.
• Pharmacy benefit inquiry (EDI 270/271): Allows pharmacies to inquire about a patient’s pharmacy benefit coverage, receiving details on drug formulary status, copayments, and medication coverage limits.
• Purchase order (EDI 850): Used by healthcare providers to order medical supplies and equipment from suppliers, detailing the types and quantities of products being ordered.
• Purchase order acknowledgment (EDI 855): Sent by suppliers to confirm the receipt and processing status of a purchase order.
• Advance ship notice (EDI 856): Provides detailed information about pending deliveries, including shipment contents and expected delivery times, enabling healthcare providers to prepare for incoming supplies.
• Healthcare service review information (EDI 278): Facilitates the exchange of information for the authorization of healthcare services, including admissions, referrals, and procedures that require pre-authorization by a payer.
• Patient information (EDI 275): Used to exchange patient information, such as medical histories, treatment records, and laboratory results, between healthcare providers, often supporting care coordination and patient transfers.
• Referral certification and authorization (EDI 278): Supports the management of referrals to specialists, including the authorization of specialized services by payers.
• Healthcare service status (EDI 277): A more generalized form of the claim status inquiry, providing updates on the status of various healthcare services beyond claim processing.

These transactions literally help to ensure that healthcare providers can deliver high-quality care efficiently. 

Unfortunately, the healthcare system is no stranger to cybercrime, including everything from employee and patient data theft, to extortion via the disabling of systems and the encrypting of critical data. Included among these threats is online vandalism, where corrupted medical records can have the direst of consequences. 

The integration of services like SFTP To Go with these EDI systems enhances their security and reliability, addressing the increasing risks and challenges in healthcare data exchange.

The challenges with traditional EDI solutions

Traditional EDI systems, despite their benefits, often struggle to meet the evolving standards of data protection, particularly in the context of stringent healthcare regulations like the Health Insurance Portability and Accountability Act (HIPAA).

EDI challenges include:

• Network exposure risk and integrational complexity: EDI communication is always encrypted, the challenge is with the variability in implementation and management, especially in legacy systems. EDI protocols like AS2 ensure secure data transmission within network boundaries, but integrating with external partners can be complex. This stems from the need to establish secure, direct connections with each trading partner, potentially increasing network vulnerability. 
• Compliance issues: Compliance with healthcare standards and regulations is another critical challenge. HIPAA mandates strict controls over the handling and exchange of PHI to ensure patient privacy and data security. Traditional EDI solutions may not always offer the necessary features to fully comply with these regulations, such as audit trails or access controls, potentially exposing healthcare organizations to legal and financial penalties.
• Integration and scalability: Integrating traditional EDI solutions with other healthcare systems (e.g., electronic health records (EHRs), practice management systems) can be complex and resource-intensive. As healthcare organizations grow and evolve, scaling traditional EDI solutions to accommodate increased volumes of transactions or to support new types of EDI transactions can be challenging.
• Interoperability issues: The lack of interoperability between disparate EDI systems used by different healthcare organizations can lead to inefficiencies and errors in data exchange. This can result in delays in processing claims, inaccuracies in patient records, and overall inefficiencies in healthcare delivery.

Introducing managed SFTP for secure healthcare data exchange

The integration of SFTP To Go’s managed cloud SFTP service with healthcare EDI systems addresses critical security vulnerabilities and compliance issues inherent in traditional EDI solutions. 

With healthcare organizations routinely exchanging large volumes of sensitive data, the powerful encryption and secure authentication mechanisms offered by Managed SFTP are indispensable.

SFTP To Go enhances healthcare EDI systems with:

• End-to-end encryption and protocol support: The use of secure access protocols (SFTP, FTPS, S3, HTTPS) ensure data confidentiality and integrity both in transit and at rest, safeguarding sensitive healthcare information. 
• Network security: Addresses the critical challenge of securing network boundaries and enhancing encryption in EDI communications. EDI systems often require complex setups that can expose internal networks to risks during data exchange. SFTP To Go simplifies this process by providing a secure, managed SFTP server that acts as an intermediary, reducing direct exposure of internal networks to external threats.
• Comprehensive compliance support: Facilitates adherence to diverse healthcare regulations, including HIPAA, GDPR, HITECH. Features like audit trails, access controls, and data integrity checks support these compliance efforts within the secure S3 environment.
• Automated file transfers: Simplifies the exchange of EDI transactions, reducing manual errors and upping operational efficiency. The integration with S3 allows for seamless and automated data storage solutions.
• Scalability and flexibility with Amazon S3: Offers scalable, durable, and secure storage solutions through Amazon S3, accommodating growing data volumes and adapting to evolving healthcare data exchange requirements without compromising security or compliance. S3's robust security features, including server-side encryption (SSE), protect data at rest.
• Interoperability: Ensures secure data exchanges across different healthcare systems and applications, facilitating integrated patient care. The use of Amazon S3 as the storage backend enhances compatibility and integration capabilities with a wide range of healthcare 
• High availability and reliability: Engineered for maximum uptime, SFTP To Go ensures that healthcare data is always accessible when needed, supporting critical healthcare operations without interruption. 
• Easy file management: An intuitive web portal ensures secure access from anywhere in the world, and easy file management options.
• Disaster recovery: Includes comprehensive disaster recovery solutions, with the continuation of uploads/downloads following in unlikely event of interruption—without the need to start over.

Integrating SFTP To Go with your healthcare EDI system

• Assessment and planning:
  • Start by evaluating your current EDI setup to understand the specific data exchange workflows, types of EDI transactions handled, and any existing challenges or security gaps.
  • Identify the key stakeholders and technical resources necessary for the integration process.
• Choosing the right plan:
  • SFTP To Go offers a tiered range of plans tailored to different needs, from small healthcare practices to large organizations. Select a plan that aligns with your volume of data exchange, required storage capacity, number of users, and preferred features.
• Setting up your SFTP To Go account:
  • Sign up for SFTP To Go and configure your account settings, including security preferences and encryption requirements. Ensure these settings comply with healthcare regulations like HIPAA.
• Integration with EDI systems:
  • Use SFTP To Go's API and SDKs for seamless integration with your existing EDI software. The platform supports various programming languages and frameworks, making it adaptable to different IT environments.
  • SFTP To Go offers standard protocols, including SFTP, FTPS, and S3, with which to interact with data, API’s to manage users and configuration, and webhooks to notify users of selected file transactions.
  • Configure your EDI system to route data exchanges through SFTP To Go's servers. This typically involves setting up SFTP endpoints within your EDI software and entering the credentials provided by SFTP To Go.
• Data mapping and automation:
  • Implement data mapping to ensure that the files transferred via SFTP To Go align with the requirements of your EDI transactions. 
  • Employ SFTP To Go's automation features to schedule regular data transfers and synchronize files between your systems and partners, minimizing manual interventions and reducing the risk of errors.
• Testing and validation:
  • Conduct thorough testing of the integrated system to verify secure data transmission, correct handling of EDI transactions, and compliance with healthcare standards.
  • Engage with your healthcare partners to test interoperability and ensure that data exchanges are performed seamlessly and securely.
• Training and documentation:
  • Provide training for relevant staff members on using the new system, focusing on security practices, monitoring tools, and troubleshooting procedures.
  • Document the integration process, settings, and operational guidelines for future reference and compliance audits.
• Ongoing monitoring and support:
  • Use SFTP To Go's monitoring and analytics tools to oversee data exchanges, track performance, and identify any issues promptly.
  • Take advantage of SFTP To Go's support resources, including comprehensive documentation, FAQs, and customer service, to ensure smooth operations and address any challenges that arise.

In conclusion

In the complex and highly regulated field of healthcare, managing data exchanges with efficiency, security, and compliance is non-optional. 

Traditional EDI systems, while foundational to healthcare communication and highly effective at what they’re designed to do, often fall short in meeting these modern challenges in full. 

SFTP To Go’ comprehensive solution, compliments and fortifies healthcare EDI with unmatched security, ease of compliance, and operational efficiency. 

What’s more, SFTP To Go’s complementary feature list, including reliable, scalable storage, automation features and powerful data security infrastructure, are easy to integrate with your existing or planned EDI system.

If you haven’t chosen an EDI provider yet, we recommend you read our post on this year’s top EDI providers, all of which integrate seamlessly with our product.

To help you navigate the complexities of healthcare data management, we've developed The Complete HIPAA Checklist: Compliance for Healthcare Providers & Business Associates in 2024/2025.

This comprehensive ebook offers a full overview of HIPAA regulations, and step-by-step guidance to ensure your healthcare organization stays compliant and prepared.

Download the Complete HIPAA Checklist for 2024/2025 and take the next step towards securing your organization’s future.