Healthcare EDI Transaction Lifecycles Embedded with a Multi-Layer Verification Framework to Ensure Referential Integrity

Abstract

This paper presents a multi-layered, systematic verification model that would enforce referential integrity throughout the life cycle of healthcare Electronic Data Interchange (EDI) transactions. Healthcare EDI systems support multi-step and complicated data transfer between patients and providers, payers and intermediates, which makes them especially susceptible to referential integrity problems. The nature of these interactions complicates them and therefore, the chances of referential integrity breach increase significantly. Traditional validation systems normally place more focus on syntactic correctness and are insufficient in identifying inconsistencies that occur at the lifecycle level. The framework suggested will alleviate this shortcoming by introducing the idea of layered verification on structural, referential, semantic, and lifecycle levels. An abstracted approach to methodology along with a systematic data analysis demonstrates the localization of integrity violations on certain transitions between lifecycle and entities. The findings suggest that despite the fact most of the transactions are good, a significant fraction has missing or broken reference that can have operational and compliance consequences. The framework as a whole enhances traceability, governance prepared, and reliability of data in the healthcare EDI setups. The paper provides a novel, lifecycle-sensitive principle upon which the provision of integrity guarantees and the maintenance of reliable, interoperable data transfer in the healthcare environment should be advanced.