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The Centers for Medicare & Medicaid Services (CMS) has released a proposal that is catching the attention of medical practitioners and health systems. The CMS is proposing changes to their interoperability requirements which has raised some concern among industry observers and organizations.

There are always new healthcare trends, federal requirements and technological innovations that make the healthcare industry an everchanging environment. But, the new requirements proposed by the CMS has healthcare organizations questioning the speed of implementation of the interoperability requirements.

The CMS is proposing a rule that would require Medicaid, the Children’s Health Insurance Program, Qualified Health Plans and Medicare Advantage plans to make patient data immediately accessible through an APIs (application programming interfaces) by January 1, 2020.

Officials at the CMS argue that for far too long patient’s electronic health information has been inaccessible for healthcare consumers. The CMS wants to break down these technological barriers in order to grant patients access to their health data. This proposed advancement in interoperability and patient access to health data would impact about 125 million Americans.

The Proposed Growth of Interoperability:

The Healthcare Information and Management Systems Society (HIMSS) defines Interoperability as an ability for different information systems, devices and applications to access, exchange, integrate and cooperatively use data in a coordinated manner. The use and exchange of information should occur within and across organizational, regional and national boundaries. Good interoperability must provide timely information that is portable and focused on both the health of individuals and global populations.

The CMS hopes that members of the healthcare system will join forces to provide patients with safe, secure access to, and control over, their healthcare data. A move that would improve the overall quality of healthcare for all Americans. The hope is that proposals like these would eventually help patients more easily find in-network providers. In addition, this would allow healthcare professionals to locate other providers which would facilitate access to patient’s medical records, referrals, transitions of care as well as care coordination.

CMS proposed Interoperability and Patient Access Proposed Rule hopes to introduce new policies that will expand access to health information and improve the seamless exchange of data in healthcare. The overriding goal of interoperability is to improve the delivery of healthcare for Americans. The objective is to reduce the administrative and technological burden for clinicians, providers and patients. All the while encouraging better care coordination and the development of a value-based healthcare system.

Concerns About Rapid Implementation:

No health system or medical provider wants to be accused of unreasonably limiting their patient’s access to their health data. However, Interoperability has long been a long-term goal and stumbling block for the healthcare industry. There are many moving parts in healthcare, and creating a seamless data delivery system is not easy.

The major tech giants have recognized this problem and are moving into the healthcare industry. Companies like Google, Apple, Microsoft and Amazon are experienced with managing and moving large amounts of data. Whether they are able to increase the amount of interoperability is the healthcare system is still unclear.

For example, using smartphones to securely access patient records is perhaps the first step. But, there are still data security issues that need to be addressed. Many industry experts and advocacy groups are concerned about protecting the privacy of patients’ health data with increased data sharing.

Healthcare industry associations like the AMA and America’s Health Insurance Plans (AHIP) are both urging CMS to take a slower, phased-in approach for interoperability. The AHIP states that the push to implement the interoperability proposal by 2020 is unrealistic. They argue that the interoperability rule should be phased-in no sooner than the year 2022. The AHIP also wants the proposal tied to the development of nationwide standards as well as consumer privacy protections for patients.

Before the proposal is finalized, the AMA is urging the CMS to develop solutions to help establish transparency in how health information is used. In addition, this transparency should include who is using the data as well as how it is being used. The AMA has stated that they want to improve patient’s accessibility to health information. They believe that better access to data has the potential to transform care delivery and improve overall patient outcomes.

However, like AHIP, they have concerns about the complexity and many layers of patient information. Much of the data is intertwined with third-parties who may possess different obligations and levels of data privacy. Both the AHIP and AMA argue that there is substantial operational complexity that the CMS does not fully realize.

Future Disruptions in Healthcare:

Many observers believe that in the next 20 years there will be dramatic changes in healthcare. The prediction is that the delivery of healthcare will be driven by a digital transformation that is made possible by secure data systems that have a high-level of interoperability.

This means that patients will act more like consumers who own their personal health data. Health systems, medical organizations and industry associations that develop and implement a strategic approach to interoperability will have a competitive advantage in this environment.

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Interoperability, AHIP, AMA, CMS