- 02/23/2022
Policy mandate on Interoperability, Data Access, HIE
Policy Mandate
- Jun 2020: ONC published the Final Rule for the 21st Century Cures Act, establishing FHIR R4 as the standard required for Health IT Certification
- Jun 2020: The 21st Century Cures Act, the ONC Cures Act Final Rule, and the CMS Interoperability and Patient Access rule have accelerated the ability for an individual to access their personal health information via an application of their choice leveraging HL7® FHIR® APIs
The ONC Interoperability and Information Blocking Final Regulation focus on enforcing aspects of the 21st Century Cures Act (interoperability, data access, and exchange/electronic health information (EHI)) and addresses the consequences of information blocking.
High-level timeline on compliance with the ONC’s Cures Act Final Rule
These rules impact patients, clinicians/providers, payers, ACOs/DCEs, vendors, developers - everybody in a healthcare ecosystem
Patients
- Access all their EHI without charge
Payers
- Implement a patient access API and a provider directory API
- Facilitate data exchange between payers using data identified in USCDI
- Increase the frequency of federal/state data exchanges
- Expose claims data via FHIR so that if a patient changes their health plan, they will be able to move data between the payers
Providers
- Update their digital contact information (in the National Plan and Provider Enumeration System (NPPES)) and/or information blocking. Failure to do so will lead to public reporting, which will affect provider performance metrics
- Improve ADT event messaging to meet care coordination requirements, allowing providers identified by the patient to receive the necessary notifications for treatment and care coordination (although CMS and ONC have yet to identify a standard for content format or delivery)
- Providers will have to send entire patient medical records to patient’s current health plan
Further Details on the Ruling!
There are three main pieces to the Interoperability and Patient Access ruling:
Patient Access API (Required July 1, 2021) – CMS-regulated payers are required to implement and maintain a secure, standards-based API that allows patients to easily access their claims and encounter information, including cost, as well as a defined subset of their clinical information through third-party applications of their choice.
Provider Directory API (Required July 1, 2021) – CMS-regulated payers are required by this portion of the rule to make provider directory information publicly available via a standards-based API. Through making this information available, third-party application developers will be able to create services that help patients find providers for specific care needs and clinicians find other providers for care coordination.
Payer-to-Payer Data Exchange (Required January 1, 2022) – CMS-regulated payers are required to exchange certain patient clinical data at the patient’s request with other payers.
Influencers and community projects to promote Interoperability
Da Vinci Project
Da Vinci stakeholders are industry leaders and health IT technical experts who are working together to accelerate the adoption of HL7 FHIR as the standard to support and integrate value-based care (VBC) data exchange across communities
Gravity Project
To create and maintain a consensus-building community to expand available SDOH (Social Detrimental of Health) core data for interoperability and accelerate standards-based information exchange by using HL7® FHIR®
CARIN
CARIN is committed to working closely with government leaders to enable consumers and their authorized caregivers to access more of their digital health information with less friction
Argonaut Project
Private sector initiative to rapidly develop a first-generation FHIR-based API and Core Data Services specification to enable expanded information sharing for EHR and other HIT based on Internet standards and architectural patterns and styles.
