2021 has already been quite tumultuous, and it has just started. We have a new President, the COVID-19 global pandemic continues to rage and in response, healthcare continues to transform rapidly to keep pace. The growth in artificial intelligence, telehealth and supporting technologies has been astounding and will only continue throughout this new year. The growth of telehealth mandates that cybersecurity practices and technology must keep pace, forcing aggressive innovation in this health information technology space.
While the global pandemic clearly overshadowed some groundbreaking and transformative federal rulemaking in 2020, these rules nonetheless remain in effect, and the “Year of Interoperability” is upon us. The 21st Century Cures Act Interoperability and Patient Access Final Rule went into effect on January 1, 2021 with an enforcement date of July 1, which is rapidly approaching. Finalized in March 2020, the Interoperability and Patient Access Final Rule from both the ONC (Office of the National Coordinator for Health Information Technology) and CMS (Centers for Medicare & Medicaid Services) aim to give patients unprecedented, safe and secure access to their health data.
Together, these mandates mark the most extensive healthcare data sharing policies the federal government has implemented, requiring public and private entities to share health information safely and securely between patients and other parties. These new interoperability rules seem especially prescient in the context of a global pandemic where such data sharing paradigms can be harnessed by public health agencies for disease surveillance, monitoring vaccine adoption and evaluating vaccine efficacy among the populace.
Healthcare data sharing is certain to revolutionize data analytics at the individual, organizational and governmental/agency levels. The FHIR® (Fast Healthcare Interoperability Resources) standard and enabling APIs are at the heart of these rules and form the foundation of true interoperability in healthcare. While the Patient Access API and Provider Directory API must be implemented by July 1, 2021, following closely is the Payer-to-Payer Data Exchange mandate, which goes into effect in January of 2022. This mandate requires most payers to exchange patient data at the member’s request so members can electronically transfer their health data as they move between plans.
Building and expanding upon the Patient Access and Interoperability Final Rule, in January of this year CMS passed another final rule (under review), CMS Interoperability and Prior Authorization. This represents the next phase of interoperability rulemaking and solidifies our federal government’s commitment to true healthcare data interoperability. This rule extends the interoperable healthcare data available to patients to also be shared with providers and other payers who have a relationship with the patient. The rule extends the available data to include active prior authorization information. The goal of this additional data exchange is to support continuity of care, reduced administrative burden and reduced costs, enabling providers to deliver higher-quality care. Again, at the heart of this rule is the FHIR standard and enabling APIs, demonstrating the federal government’s commitment to this open standard.
In conclusion, while we are merely scratching the surface of these final rules, it is clear that interoperability is a high priority for our federal government, and with enforcement dates in this calendar year, it has made 2021 the Year of Interoperability. It is important that we view these proposed rules as promoting customer engagement and empowerment, not merely as a federal compliance requirement. At Gainwell, innovation is a priority, and we are committed to helping our clients meet these current and future mandates with our Patient Access and Interoperability Solution. Stay safe.
About the Author
Jeff Turpin is the CTO of the Product organization at Gainwell. He has more than 20 years of enterprise software development experience, with over 7 years focused on healthcare. With a deep passion for technology, Jeff has built large, distributed systems and analytics platforms for use in commercial healthcare and other industries, both domestically and abroad. Jeff loves building and working with highly effective software development teams with a focus on delivery and engineering excellence. Jeff lives in Tucson, Arizona.