Interoperability and the Connected Health Care System

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

On December 8, 2021, a blog authored by Chiquita Brooks-LaSure, Administrator for the Centers for Medicare & Medicaid Services (CMS) was posted.

“The COVID-19 pandemic exposed many shortcomings in our health care system, especially the ability to quickly share and use reliable data to better understand the health needs of all people across the country. This need for more accessible data is why the Centers for Medicare & Medicaid Services (CMS) remains committed to making health care data flow more freely and securely among payers, providers, and patients by laying the foundation to foster a more connected health care system.

CMS is working toward this goal by increasing and advancing health care data exchange functionality to better inform decision-making for patients and their providers, support and improve patient care, and reduce the administrative burden on providers and payers. The Biden-Harris Administration is committed to increasing health data exchange and investing in interoperability – the ability for computer systems to exchange information between devices and software systems. These goals are key components of our strategy to promote a more equitable and efficient health care system.

On May 1, 2020, CMS published the CMS Interoperability and Patient Access Final Rule, establishing policies that advance interoperability and access to health information for all stakeholders. This rule made sure patients can have convenient access to their health care data through a personal health app. Specifically, CMS requires certain payers to build standardized Application Programming Interfaces (APIs) that allow for a more secure data exchange process between the payer and a patient’s chosen personal health app. This rule is just one step in a larger journey toward achieving a health care system where patients, providers, and payers can easily exchange information to bolster better care outcomes.

This rule also established a requirement for certain payers to build standardized APIs to exchange data with other payers, with the goal of enabling patients’ health data to follow them if they switch health insurance plans. While we are excited about what payer-to-payer information exchange can do to accelerate the flow of such data, it is vital that: 1) the policy supports patients in the ways they need, and 2) payers are able to effectively and successfully implement these new features. To that end, CMS heard concerns from the payer community about operational challenges and risks to data quality in the absence of specific data exchange requirements and standards, particularly the lack of a requirement for a standards-based API. Accordingly, to ensure payers are in a position to effectively contribute toward our shared goals for interoperability, CMS recently exercised enforcement discretion with regard to the payer-to-payer data exchange provision, meaning the agency will not take any action against payers should they not meet the original deadline until CMS can improve the policy through future rulemaking. This step will also give payers more time to come into compliance with the provision when a new rule is published.”

The above is an excerpt from the Administrator’s blog. I encourage you to read the entire blog.  Please share it with your team and colleagues.