The U.S. Centers for Medicare & Medicaid Services (CMS) recently introduced new interoperability mandates as part of the Interoperability and Patient Access final rule. The new CMS interoperability rule, which took effect on July 1, 2021, will benefit healthcare providers, practices, and patients in various ways—but there are still a few critical considerations to keep in mind in order to adapt.
Keep reading to learn everything you need to know about the CMS interoperability rule.
What Is the New CMS Interoperability Rule?
Lack of seamless, secure data exchange has been a long-time pain point in healthcare, detracting from patient care, increasing costs, and potentially leading to poor health outcomes. CMS’s new interoperability rule is designed to break down technical and regulatory interoperability barriers, enabling better patient access to health records.
The new CMS interoperability rule mandates that every patient have access to data electronically through a Patient Access API, available on demand and in a useful format. The goal is to equip patients with the information they need to make better healthcare decisions and provide transparency around care costs and quality. Similarly, payers are now required by this ruling to make clinical information publicly available via a standards-based Provider Directory API.
As part of the CMS interoperability rule, providers must demonstrate that their electronic health records (EHR) solutions are compliant with federal data exchange standards and regulations. Health Level 7® (HL7) Fast Healthcare Interoperability Resources® (FHIR) Release 4.0.1 has been deemed the foundational standard to support data exchange via secure APIs. Additionally, providers must enter their digital contact information in the National Plan and Provider Enumeration System (NPPES) system.
Want more detailed information? Access the full CMS interoperability rule.
Key Benefits of the CMS Interoperability Rule
As previously stated, the new CMS interoperability rule will benefit healthcare providers, practices, and patients alike. Here’s how:
Benefits for Patients and Consumers
The benefits for healthcare consumers and patients are clear: They’ll gain better access to their health records, as well as better data privacy and security. With access to insightful, actionable data when they need it, patients can take a more active and informed role in their own care decisions.
Plus, the new ruling will help lead to lower healthcare costs overall by minimizing duplicate testing and other inefficiencies.
Benefits for Practices and Providers
Healthcare practices and providers will also benefit from the new CMS interoperability rule, which ensures they have access to each individual’s medical and care history to make more informed clinical decisions. This will reduce unnecessary errors, improve patient safety, and enhance care coordination, while also allowing providers to achieve more positive health outcomes.
The rule will also reduce the administrative and technological burden for practices and providers, making patient record information requests easier, efficient, and cost-effective.
How Should Practices and Providers Adapt?
All that being said, one question remains: How will this change the ways providers and practices offer care to patients? To adapt to this rule, many provider organizations—not to mention the vendor partners they work with—will need to update or even rebuild their systems to ensure compliance with specified access rules and required APIs.
Your practice can get up to speed by taking the following steps:
Aggregating and Collating Data
Healthcare practices are certainly no stranger to data, and it often comes from a variety of sources. With patient data dispersed across various systems—and in different formats—practices need a way to aggregate, collate, and ultimately centralize it in a single, unified database.
Identifying Data Quality Issues
To comply with the new interoperability standards, practices must compile a full set of accurate data for each patient. However, siloed data presents another challenge: quality issues. Bringing together disparate data is sure to spotlight missing, conflicting, corrupt, and duplicate data, which will need to be addressed to ensure compliance.
Addressing Any Security Concerns
With healthcare data so much more readily accessible, practices will need to ensure APIs are secure. For many, that will mean holding third-party vendors such as EHR companies accountable for data security.
Complying with the new CMS interoperability rule may seem challenging at first, but with the right plan, processes, and technology in place, practices like yours can quickly adapt and meet regulatory requirements with ease—and increase engagement in the process.