Hook

Hook provides a solution that automates the prior authorization process in healthcare using Coverage Requirements Discovery (CRD) with CDS Hooks and AWS HealthLake. The solution leverages the CRD implementation guide, which facilitates calls between electronic health record (EHR) systems and payers using CDS (Clinical Decision Support) services. This enables providers to make informed decisions and meet patients' insurance coverage requirements seamlessly.

The solution utilizes CDS Hooks, an HL7 specification that embeds additional functionality within an EHR's workflow. By integrating CDS Hooks with AWS HealthLake, the solution automates the prior authorization process, including determining whether prior authorization is required, gathering necessary information, and submitting requests.

The workflow involves the EHR system invoking AWS Lambda functions through API Gateway. These functions retrieve patient condition information and claims data from HealthLake, run Clinical Quality Language (CQL) rules based on the medication and claims information, and determine if prior authorization is necessary. The solution provides decision support to providers at the point of ordering diagnostics, treatments, referrals, or appointments, enabling them to navigate prior authorization requirements in real-time.