The federal government's proposed interoperability rule with major new requirements for payers and could create true data interoperability, opening the way to more efficient processes, enhanced quality of care—and new business models and competition.
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 health care payers’ electronic health record (EHR) record sharing and improving member access to their medical records. But sharing EHR data throughout the health care 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 health care data starting now,” said Jay Sultan, VP at Cognizant working on health care strategy. “By mandating that payers all have a common API, common terminology, and common mandates for sharing data with both patients and other health care 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 health care information will fundamentally change the way patients receive and experience health care.”
Cognizant’s latest perspective looks at the key aspects of the rules that health care executives must understand and address.
The 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. health care 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 CMS and the 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 health care 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.
To learn more, click here to read Cognizant’s perspective, Preparing for the Interoperability and Patient Access Rules: Five Key Things Healthcare Executives Must Know.