At the moment, interoperability—the ability for disparate technological systems in healthcare to “talk” to one another—is facing some roadblocks. We go into detail on the subject in our white paper, but suffice it to say that new solutions are needed. In that vein, the Centers for Medicare and Medicaid Services (CMS) released new guidelines in 2019 that healthcare centers and tech organizations across the country can use to improve their efforts at interoperability. Here’s your quick guide to the new CMS guidelines for promoting interoperability, with the rules rewritten as plainly as possible.
Note: All of these guidelines only directly affect the organizations and programs under CMS’s purview, but since so much of healthcare is intertwined with those organization and programs, the proposed changes would affect most of the industry anyways.
1. Patient Access Through Application Programming Interfaces (APIs)
Have all organizations use a single HL7, FHIR-based API so that patients can access their health information and claims through third-party applications.
2. Health Information Exchange and Care Coordination Across Payers
Have all organizations freely exchange electronic data to make sure that all health data is shared when patients change their insurance payer.
3. API Access to Published Provider Directory Data
Provider directories are incredibly important: patients can use them to determine if their provider or potential provider is in- or out-of-network, and healthcare professionals use them to access health records from other professionals. This proposal would have all organizations make all of their provider directories available through API technology.
4. Care Coordination Through Trusted Exchange Networks
Expand the number of trusted networks in which plans and providers can freely and securely share private information nationwide.
5. Improving the Dual Eligible Experience by Increasing Frequency of Federal-State Data Exchanges
Require states to improve the rate of data sharing concerning patients eligible to receive both Medicare and Medicaid from monthly updates to daily. Continue to improve federal and state data sharing for those who benefit from both of these programs.
6. Public Reporting and Prevention of Information Blocking
Require patients and caregivers to be informed and the information publicly known if a clinician, hospital, or care center fail to prevent information blocking within their systems.
7. Provider Digital Contact Information
Create a single directory of digital provider contact information so that “the flow of patient information and any needed provider-to-provider communication is seamless for all users.” Add or publicly report providers who haven’t added their digital contact information within the same system by the end of 2020.
As an added bonus, CMS proposes that this could eliminate the need for fax machines to exchange health information.
8. Revisions to the Conditions of Participation (CoPs) for Hospitals and Critical Access Hospitals
Require electronic notifications to be sent to related hospitals when a patient is admitted, discharged or transferred to ensure that basic health and safety standards for patient discharge and/or transitions are followed.
9. Advancing Interoperability in Innovative Models
Design, test, and promote innovative payment and service delivery models that work with non-traditional data (such as steps counted on your phone, nutritional intake reported through an app, etc.) and patient portals.
So far, these CMS guidelines for promoting interoperability have been met with some support and some skepticism in the industry. While many agree with the spirit and intent of these guidelines, others criticize the fast-moving timeline as untenable and some of the guidelines as too strict, impractical, or unrealistic.
If you’re interested in using your skills to bring some of these guidelines to life to improve interoperability in the healthcare, you might be a health informaticist in the making! Check out our infographic on the salaries and skills of health informaticists today: