Optimizing Infectious Disease SMART on FHIR Prior Auth Workflows

The Challenge of Infectious Disease Prior Authorizations

Infectious disease specialists frequently prescribe high-cost medications and complex treatment plans that require prior authorization, including advanced antivirals for conditions like HCV and HIV, critical antifungals, and extensive outpatient parenteral antibiotic therapy (OPAT). Securing these approvals typically involves navigating multiple payer portals or disparate systems, pulling extensive clinical documentation, and managing complex medical policies, often informed by guidelines from bodies like NCCN and IDSA.

Transforming ID PA with SMART on FHIR

SMART on FHIR provides a standardized framework for launching prior authorization applications directly within the Electronic Medical Record (EMR) interface. This integration eliminates the need for clinicians or coordinators to leave the EMR, significantly reducing context-switching and the potential for manual data entry errors. Klivira leverages SMART on FHIR to bring the prior authorization workflow for infectious disease treatments into the heart of clinical operations.

Key Benefits for Infectious Disease Workflows

• **Reduced Context-Switching:** Clinicians and PA coordinators initiate and complete prior authorizations for ID treatments without leaving EMRs like Epic, Cerner, athenahealth, or MEDITECH.
• **Automated Data Transfer:** Patient and encounter context, including US Core FHIR resources, are automatically pulled from the EMR, eliminating manual retyping and transcription errors for complex ID regimens.
• **Streamlined Documentation:** Klivira's SMART on FHIR app facilitates the assembly of necessary clinical documentation, supporting Da Vinci DTR where available, crucial for high-cost antivirals and antifungals.
• **Structured Outcome Write-Back:** Prior authorization decisions and status updates are written back to the EMR as structured FHIR resources (DocumentReference, Communication, Task), ensuring consistent and queryable data for ID cases.

Klivira's SMART on FHIR Implementation for ID Prior Auth

Klivira's platform is engineered for seamless integration, utilizing SMART App Launch for secure, context-aware access from leading EMRs. Our solution reads critical FHIR R4 clinical context, such as diagnoses, medications, and lab results, directly from the EMR's FHIR endpoint. This robust integration supports the full Da Vinci stack, including CRD for coverage requirements discovery and PAS for electronic prior authorization submissions, ensuring a consistent experience across all integrated systems.

High-Volume Infectious Disease PA Categories Streamlined by Klivira

• **Antivirals (HCV, HIV):** Automated submission for complex, high-cost antiviral regimens, reducing time-to-therapy.
• **Antifungals:** Efficient prior authorization processing for specialized antifungal treatments often requiring detailed clinical justification.
• **OPAT (Outpatient Parenteral Antibiotic Therapy):** Streamlined approvals for extended home-based antibiotic infusions, ensuring continuity of care.

Connecting EMRs to Payer Channels for ID Treatments

Beyond EMR integration, Klivira connects to a comprehensive network of payer channels. This includes support for electronic prior authorization (ePA) via Da Vinci PAS, as well as traditional X12 278 transactions and NCPDP SCRIPT for pharmacy benefits. This multi-channel approach ensures that prior authorization requests for infectious disease treatments, regardless of their specific requirements, are submitted accurately and efficiently to the appropriate payer.