Interoperability: Digitally Connecting Patients, Providers and Payers
Interoperability seeks to remove data barriers and silos within the healthcare industry, connecting people with the information and tools they need to make informed decisions about their health.
Overview of Interoperability
In March 2020, the Centers for Medicare and Medicaid Services (CMS) finalized its Interoperability and Patient Access Rule (CMS-9115-F) which aims to enhance patients’ control over their healthcare information. This was published alongside the Cures Act Final Rule from the HHS Office of the National Coordinator for Health Information Technology (ONC), which establishes further standards around interoperability practices.
Interoperability will be a long-term, strategic transformation of our industry focused on operational efficiencies, higher quality medical care, and improved health outcomes. By ensuring that payers and providers are using common data formats and applications, the Interoperability Rule will allow patient health information to be shared quickly and easily via third party applications that can be downloaded on a patient’s phone. Through these digital enhancements, [Health Plan Name] will be able to improve collaboration with our members, provider networks, government entities and other payers.
What This Means for Providers
Having patient medical information and history in one place helps providers better understand their patients’ health so they can make informed care decisions and improve health outcomes. Access to this information will also improve partnership and care coordination between providers and payers.
The Interoperability Rules have three main areas of focus for providers to ensure they are properly supporting digital patient access to healthcare information. These include:
- Information Blocking Prevention: Providers will need to have policies and procedures in place to ensure information blocking practices are prevented. These include any practices that interfere with the access, exchange, or use of electronic health information (EHI).
- Up-to-Date Digital Provider Information: CMS will now require all individual health care providers and facilities to take immediate action to update their National Plan and Provider Enumeration System (NPPES) records online to add digital contact information. Providers should work with their electronic health record (EHR) vendors to ensure up-to-date digital information and current National Provider Identifier (NPI) is routinely updated.
- COP Compliance: The Interoperability Rule introduces a new Medicare Condition of Participation (COP) that requires all hospitals to send electronic notifications to a patient’s healthcare providers (e.g., primary care practitioner) upon the patient’s admission, discharge or transfer (ADT).
How Buckeye Supports Interoperability
- Buckeye will offer a secure, standards-based application programming interface (API) that allows our members to easily access their own health care information – including claims, medical history, lab results and more – through a third-party app of their choice.
- Our members will also have access to their own electronic health records (EHR), privacy and security educational resources.
- Our provider directory information will be made publically available via our API. This will help members and providers alike to use third-party apps to connect with other providers for care coordination.
- We have built secure processes for data exchange with other payers that aligns with the ONC rule’s technical standards.
Interoperability Resources and Guidance
The CARIN alliance is a bipartisan, multi-sector collaborative working to advance consumer-directed exchange of health information. Learn more about third-party application privacy standards at CARIN Alliance.
The CARIN Code of Conduct is a set of industry-leading best practices these applications have voluntarily adopted to protect and secure patient health information. It requires third-party application developers to prove they will follow certain privacy standards through attestation. Visit MyHealth Applications for a list of apps that have attested to the CARIN Code of Conduct.
Fast Healthcare Interoperability Resources® (FHIR)
FHIR is a Health Level Seven International (HL7®) standard for exchanging healthcare information electronically. It is the next generation exchange framework being adopted by the healthcare community to advance interoperability. Education and resources can be found at eCQI.healthit.gov.
We encourage our provider partners to seek sources of truth around interoperability, including the online resource hubs on the CMS and ONC websites.