Interoperability means different things to different people. For physicians, it might mean more time to take care of their patients. For digital health vendors, it means the ability to seamlessly integrate into everyday workflows of healthcare organizations. For patients, it means control over your own data – a concept that is familiar and expected in all other industries. No matter what interoperability means to you, one thing is for sure: the healthcare industry needs to achieve it.
To understand the interoperability rules fully, it’s important that we first take a step back from the legal language, and breakdown what the rules mean in everyday terms.
“This final rule implements certain provisions of the 21st Century Cures Act, including Conditions and Maintenance of Certification requirements for health information technology (health IT) developers under the ONC Health IT Certification Program (Program), the voluntary certification of health IT for use by pediatric health care providers, and reasonable and necessary activities that do not constitute information blocking. The implementation of these provisions will advance interoperability and support the access, exchange, and use of electronic health information. The rule also finalizes certain modifications to the 2015 Edition health IT certification criteria and Program in additional ways to advance interoperability, enhance health IT certification, and reduce burden and costs.” – U.S. Department of Health and Human Services
The first rule is referred to as the “ONC’s Cures Act Final Rule.” This rule encourages communication through standardization. The rule itself has guidelines around adopting standardized application programming interfaces (APIs). This will allow easier access to health information for patients and providers alike, through something as accessible as a smartphone application. The rule also states that patients can access their health information at no cost, and implements the information blocking provisions of the Cures Act
“This final rule is intended to move the health care ecosystem in the direction of interoperability, and to signal our commitment to the vision set out in the 21st Century Cures Act and Executive Order 13813 to improve the quality and accessibility of information that CMS-9115-F CPL 03/06/20 2 Americans need to make informed health care decisions, including data about health care prices and outcomes, while minimizing reporting burdens on affected health care providers and payers.” – U.S. Department of Health and Human Services
The second rule is the CMS Interoperability and Patient Access final rule. The heart of this rule is the “patient-first” mindset, supporting the previous rule by giving patients access to their health information when they need it most and in a way they can use it. To enforce the rule, CMS authority will regulate Medicare Advantage, Medicaid, CHIP, and Qualified Health Plan issuers on the Federally-facilitated Exchanges to liberate patient data.
Looking at these rules, it’s easy to conclude that it will have a large affect on the healthcare industry. Just like interoperability, these rules mean different things to different people. How will they affect you?
This rule reinforces the idea that we don’t have to choose between privacy and transparency when it comes to patient data; we can have both. The call for open APIs with predictable standards will allow healthcare organizations of any size to improve care coordination and share information securely with their patients. It also removes ambiguity around data standards, so healthcare organizations will be able to communicate more easily with partner organizations when patients are being transferred to different facilities.
This rule helps healthcare data and systems become more standardized, so digital health vendors should be able to connect to other systems and exchange data more seamlessly than ever before. However, with great power, comes great responsibility. There are certification requirements that health IT developers will have to consider and ensure they are meeting. You can see the full requirements in this data sheet. Digital health vendors who already have certified their API have 6 months from the rule’s effective date to meet the new API Conditions of Certification. When it comes to their customers, these digital health vendors will need to provide them with newly certified technology within 24 month’s of the effective date.
In the long run, payers stand to benefit from this rule. When members have easy access to their personal health information, they can make better decisions regarding their care, ultimately leading to healthier populations — a huge win for payers. In a future where data flows freely and securely between payers, providers, and patients, we can achieve truly coordinated care, improved health outcomes, and reduced costs. However, this rule presents an especially unique challenge for payer organizations considering the large amount of member data that exists across their highly customized disparate systems. One of the largest obstacles that payers may face when working to connect their disparate systems is finding an integration strategy that works not only for the systems they use, but accounts for the customization that each of their systems have.
Odds are, you and your organization are already making strides towards achieving interoperability at your organization. This 1200 page interoperability rule may seem daunting, but you’re not alone. There are plenty of resources out there to help you get started, including some from Bridge Connector’s own resource center.
Here are a couple key pieces of content that can help your organization take steps towards interoperability:
Still feeling unsure? If you’re a provider, payer, or digital health vendor, connect with a Bridge Connector integration expert and learn what solution is best for your organization.