What healthcare executives must know about the interoperability and patient access rules



Years ago, the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Health Coordinator (ONC) began promoting interoperability with the goal of improving healthcare payers electronic health record (EHR) record sharing and improving member access to their medical records. But sharing EHR data throughout the healthcare field is just one focus of interoperability.

Earlier this year, CMS and ONC published a proposed interoperability rule with major new requirements for payers.  The new interoperability mandate includes three important functions:

  •        Securing the exchange of electronic medical data without additional patient effort.
  •        Allowing access, exchange and use of all electronically accessible health information for authorized users under applicable laws.
  •        Eliminating interference in the exchange and use of electronic health information.

With these requirements in mind, how can payers prepare their data for interoperability?

”The result of this government action is that a new interoperability format called FHIR will be the common and ubiquitous method for sharing healthcare data starting now,” stated Jay Sultan, VP at Cognizant working on healthcare strategy.  “By mandating that payers all have a common API, common terminology, and common mandates for sharing data with both patients and other healthcare professionals, the government is changing the industry behavior and functionality, just as it did when it mandated the 4010 standards for electronic claim processing decades ago.  This change is similar in scope but even larger in impact, as unlocking healthcare information will fundamentally change the way patients receive and experience healthcare.”

Preparing for the Interoperability and Patient Access Rules: Five Key Things Healthcare Executives Must Know

Sweeping proposals could create true data interoperability, opening the way to more efficient processes, enhanced quality of care — and new business models and competition.

The average U.S. healthcare payer is probably not ready to share five years’ worth of a member’s clinical data with a competitor on demand. Yet, that’s one of the key requirements in the two new complementary interoperability and access rules that the Centers for Medicare & Medicaid (CMS) and the Office of the National Health Coordinator (ONC) introduced this past February for payers and providers under the 21st Century Cures Act. The stated goal: To advance interoperability and make it easy and simple for healthcare consumers to access their own medical data.

While the rules are not yet final, they have the potential to fundamentally change the use of data and technology by all industry stakeholders. The rules will certainly have a nearly immediate, deep and wide impact on payer operations, IT planning and business strategy. Here are five key aspects of the rules that healthcare executives must quickly understand and address.

To read the Five Key Things Healthcare Executives Must Know, click here.