Patient Care at Center at Interoperability

Original story posted on: February 18, 2019

CMS and ONC get serious about interoperability during HIMSS.

During the HIMSS 19 conference in Orlando last week, the heads of the Office of the National Coordinator (ONC) for Health Information Technology and the Centers for Medicare & Medicaid Services (CMS) took extraordinary steps by discussing the content of two proposed rules to be published shortly. Donald Rucker, MD, head of the ONC, and Seema Verma, CMS Administrator, used the annual healthcare IT event to promote interoperability, long a goal of HIMSS.

These rules would create a structure to allow patients to electronically receive their clinical data and their claims data with standardized, easy-to-use applications. The rules would require electronic health records (EHRs) and Medicare, Medicaid, Medicare Advantage, and Exchange health plans to have a specific technology in place that allows for individuals and providers to easily access standardized data and formats. This will enable app developers to take that data and use it to benefit patients and their caregivers.

The ONC proposed rule focuses primarily on EHR certification requirements. To be newly certified, EHRs must:

  • Use the Health Level 7 (HL7®) Fast Healthcare Interoperability Resources (FHIR®) standard, along with a set of implementation specifications that would provide known technical requirements against which app developers and other innovative services can be built.
  • Provide API access to and search capabilities for all data proposed as part of the United States Core Data for Interoperability (USCDI) for a single patient and multiple patients.
  • Support secure connections that include authentication and authorization capabilities in ways that enable, for example, patients to use an app to access their EHI without needing to log in each time they use the app.

Not only would this give patients access to their data, but it also would enable easy movement of data for a provider if they choose to switch EHRs, and for patients if they choose to switch providers. Note that the proposed rule also says that this data should be made available at no cost to the patient.

The CMS proposed rule would place similar requirements on Medicare, Medicaid, and Exchange health plans to make claims data available to individuals. These plans (Medicare Advantage (MA) organizations, state Medicaid and CHIP FFS programs, Medicaid managed care plans, CHIP managed care entities, and QHP issuers in FFEs) would be required to implement openly published Health Level Seven (HL7®) Fast Healthcare Interoperability Resources (FHIR®)-based APIs to make patient claims and other health information available to patients through third-party applications and developers. 

These plans also would be required provide the data to enable patients to switch among plans, and make their provider directories available through these same standardized APIs. 

The agencies have now adopted specific technology and data content standards so that data can move freely throughout the healthcare system. CMS and ONC believe that this data availability is central to moving the industry forward to coordinated care and value-based payment models.

There are a number of other provisions and requests for information in the rules, including prohibitions against information blocking (and exceptions), as well as for standards advancement and patient matching. Comments on the proposed rules will be due by mid-April.

Comment on this article

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Stanley Nachimson, MS

Stanley Nachimson, MS is principal of Nachimson Advisors, a health IT consulting firm dedicated to finding innovative uses for health information technology and encouraging its adoption.   The firm serves a number of clients, including WEDI, EHNAC, the Cooperative Exchange, the Association of American Medical Colleges, and No World Borders.  Stanley is focusing on assisting health care providers and plans with their ICD-10 implementation and is the director of the NCHICA-WEDI Timeline Initiative.  He serves on the Board of Advisors for QualEDIx Corporation.

Stanley served for over 30 years in the US Department of Health and Human Services in a variety of statistical, management, and health technology positions.  His last ten years prior to his 2007 retirement were spent in developing HIPAA policy, regulations, and implementation planning and monitoring, beginning CMS’s work on Personal Health Records and serving as the CMS liaison with several industry organizations, including WEDI and HITSP.  He brings a wealth of experience and information regarding the use of standards and technology in the health care industry.

Related Stories

  • Overview of ICD-10-CM and PCS Coding Guideline Changes for 2021
    The Inpatient Prospective Payment System (IPPS) Final Rule for the 2021 fiscal year has been finalized, including updates to the guidelines that need to be implemented for ICD-10-CM and PCS. The following is an overview of what’s in store for…
  • Best Practices for How to Avoid an Audit
    As payors both in government (Medicare) and the commercial arena (private plans) see the recoupment rate of services billed incorrectly or non-compliantly skyrocket, the payor audit is not going away anytime soon. This awareness is now producing more audits of physicians than…
  • Final FY21 ICD-10-PCS Codes Are Here
    The FY21 ICD-10-CM codes will be finalized this month. The Centers for Medicare and Medicaid Services (CMS) released the final FY21 ICD-10-PCS codes on May 28, 2020 which was earlier than expected.  The table below will show the changes between…