The Centers for Medicare and Medicaid Services (CMS) has laid the critical groundwork to create a connected healthcare system in which patients, providers, and payers can easily exchange information. This is thanks in part to the release of the Interoperability and Patient Access Final Rule. With new policies now in place, CMS aims to generate better health outcomes through improved interoperability and better access to health information for all stakeholders.
CMS has also identified a new data exchange standard – Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) Release 4.0.1. – to enable the exchange of patient information throughout the healthcare system with optimal flexibility and minimal friction using application programming interface (API) platforms.
Excitingly, in addition to giving states and healthcare organizations the guidelines needed to meet the rules and requirements set forth by CMS, the FHIR standard creates an opportunity to realize truly connected, optimized, patient-centered healthcare. As such, the rule goes beyond simply improving technology; it also serves to change our perspectives and encourage the adoption of capabilities that enable data to flow freely, and securely, to benefit the masses.
By working to remove barriers to data exchange, the goal of the CMS rule is in line with that of states and payers – reduced costs and improved outcomes. Now, to achieve this promise of real change, it comes down to a true, shared commitment from all healthcare stakeholders.
Breaking Down Barriers and Removing Silos
Today, most patients are unable to obtain a cohesive view of their health data from general practitioners, specialists, and other clinicians. This prevents patients from formulating a complete picture of their health history or showing the various pieces to someone who can put it all together for them.
However, with the final rule from CMS, we’re able to address these longstanding barriers and silos by making disparate systems as interoperable as possible. This liberation of data, however, is only the starting point. To ensure organizations can exchange data as effectively and securely as possible, prioritizing data governance is critical to reducing the risk of data quality concerns.
Health systems that review their data and regularly conduct quality checks will reap the benefit of proactively identifying and correcting errors and disparities. It’s also important for organizations to move forward as quickly as possible because, once a database has been vetted and optimized, the information it holds will deliver the value of greater efficiency, better decision-making, and improved health outcomes.
Embracing Innovation to Create a Connected System
As states and payers move quickly to comply with the interoperability ruling, which secures eligibility for federal funding and prevents potential fines, it’s important for all stakeholders to stay focused on the long-term goal of creating a truly connected healthcare system. Compliance that only strives to follow regulations by implementing compatible frameworks and APIs is, ultimately, a short-sighted approach that puts the bigger picture of interoperable healthcare at risk.
By addressing compliance issues first and being nimble and innovative as technologies are implemented, organizations will be positioned to embrace interoperable care delivery and processes.
Making Small Changes Today
The steps required to achieve interoperability are clear, but what’s particularly exciting about this mission is the breadth of value and change that can come with it.
Once interoperability is established, systems will efficiently process data from a range of sources, and organizations will be able to utilize artificial intelligence and perform data analytics that will help deliver better outcomes to end users. As a result of the improved flow of clean data between entities, organizations can then implement enhancements such as machine learning and predictive analytics to garner greater value from the data.
When it comes to innovation, organizations that prioritize system upgrades (thereby reducing the technical debt), commit to focusing on data governance and adopt CMS-recommended FHIR standards will be best positioned to reduce expenditures and enjoy a gradual learning curve. The key is to take an incremental approach and start these value-add initiatives as soon as possible, versus attempting an all-at-once implementation.
The opportunities for innovation to create better health outcomes are drawing closer. Committing to interoperability beyond compliance will make this an exciting and transformative moment in healthcare.
About Rajesh Sharma
Rajesh Sharma is a vice president and general manager overseeing Gainwell Technologies’ systems integration, interoperability and data analytics product offerings. He is a techno-functional leader helping public sector healthcare clients achieve health outcomes and equity using best-in-class technology.