Promoting interoperability

Two new proposed rules providing parameters on how healthcare providers and insurers share medical data were announced by the Centers of Medicare and Medicaid (CMS) and the Office of the National Coordinator for Health IT (ONC).  The proposals reflect an industrywide trend toward appropriate sharing and use of health data to enhance patient care and eventual outcomes.  Since the comment period was recently extended to June 3, providers and payers should take the time to consider the proposals’ implications, as outlined in the attached issue brief.  

• Requirements for payers would include:

  • Implementing open application programming interfaces (APIs) to allow third-party applications to easily retrieve various types of clinical data, as long as there is patient consent.

  • Making drug benefit data available through the APIs (except in the case of those offering qualified health plans).

  • Allowing electronic health data to be exchanged with other payers (with the exception of Medicaid and CHIP agencies).

• Requirements for hospitals would include:

  • Sending automated notifications to other treating providers and facilities when a patient is admitted, discharged, or transferred (applicable to most hospitals).

  • Being prepared for penalties and/or public reporting in the event of actions perceived as “information blocking.”

In addition to comments on the language in the proposed rules, CMS and ONC are requesting input on such related issues as pricing transparency, health IT adoption, and patient matching, among others.