EHR / EMR (340B Context)
Definition
Electronic Health Records (EHR) and Electronic Medical Records (EMR) are digital systems that store patient health information, including clinical encounters, diagnoses, prescriptions, and insurance information. In the 340B context, the EHR is the primary source of patient eligibility data—it contains the information needed to determine whether a patient has an established care relationship with the covered entity.
The EHR feeds patient eligibility data to the split-billing software or TPA platform, which uses it to determine which prescriptions qualify for 340B pricing. The accuracy and timeliness of EHR data directly affects the accuracy of 340B eligibility determinations.
Common EHR-related 340B compliance issues include: delayed eligibility data causing prescriptions to be processed before eligibility is confirmed; incomplete encounter data causing eligible patients to be missed; and data mapping errors between the EHR and split-billing software causing incorrect eligibility determinations.
EHR upgrades, migrations, or configuration changes can disrupt the data feeds that support 340B operations and should be carefully managed with compliance implications in mind.
Frequently Asked Questions
Why EHR / EMR (340B Context) Matters
The EHR is the source of truth for patient eligibility in the 340B program. EHR data quality issues directly affect compliance accuracy. System changes must be carefully managed to avoid disrupting 340B data flows.
How Virtue 340B Uses It
Virtue 340B evaluates EHR-to-split-billing data flows as part of our audit and monitoring services, identifying data quality and mapping issues that affect eligibility determination accuracy.