Tag: CMS Guidelines

Overcoming Four Key Health IT Challenges In Complying with New CMS Guidelines

By Mifan Careem, vice president of solutions architecture, WSO2.

Mifan Careem

In 2020, we’ve seen the pandemic accelerate the need for greater healthcare interoperability and digital solutions. Notably, providers that have offered telemedicine, virtual visits and other digital services fared better than those that have not.

At the same time, provider and payer organizations are now more focused on value-based care measured by patient outcomes rather than reactive patient care. Such innovations have been made possible by integrated data sources within and across the healthcare organization.

Too often however, the lack of interoperability continues to stifle innovation that would otherwise benefit the healthcare industry’s most important stakeholder: the patient. The Office of the National Coordinator (ONC) Cures act and the Centers for Medicare & Medicaid Services (CMS) Interoperability and Patient Access Final Rule (CMS-9115-F) set to go into effect on July 1, 2021, aim to change that.

The new ONC and CMS rules, which target U.S. organizations, require healthcare payers and providers to provide patients with open access to their data and a secure data exchange between the different parties. As a result, patients should have improved access to health information. Meanwhile, the improved interoperability among providers and payers is expected to trigger innovation and pave the way to a newer app ecosystem.

APIs are key to compliance

Interoperability is a critical component within the healthcare system as records are digitized and must be easily shared between institutions and payers to improve the overall care of patients. The lack of interoperability is hampering the industry’s ability to transform and streamline services. While there have been attempts by the organizations including Health Level Seven (HL7) to promote interoperability and responsible data sharing over the years, concerns and issues with granting patients access to their data remain.

To achieve successful interoperability, healthcare payers and institutions must use APIs—specifically those aligned with the Fast Healthcare Interoperability Resources (FHIR) standards—to exchange structured healthcare data, such as those used for electronic health records (EHRs), digital health applications and patient use.

The CMS rule is designed to help simplify how payers and providers use APIs to drive interoperability and data sharing. However, as with all regulations, CIOs need the right strategy to implement the technology and steps to ensure compliance. As this is a new rule, there are no prior examples to follow, and if CIOs do not effectively follow a strategy, they may be found at fault on July 1.  

There are four challenges that healthcare CIOs will need to overcome to ensure successful compliance and more importantly the transition to a patient-centered approach—with services delivered when, and where, consumers want.

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