Updated on July 30, 2021 by Jordan McGlone
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In May 2020, the Centers for Medicare & Medicaid Services (CMS) released a new regulation regarding data accessibility. It is part of a greater initiative, called myHealtheData, that aims to give patients control of their medical information and allow that data to follow them and inform better healthcare services. The Interoperability and Patient Access final rule (CMS-9115-F) went into affect in on April 30, 2021 and now the requirements for hospitals with certain EHR capabilities to send admission, discharge, and transfer notifications to other providers are in effect.
As of this month–July 2021–CMS’ new Interoperability and Patient Access standard will work to improve interoperability and provide patients with better access to their electronic health information. Is your practice compliant with the new Interoperability and Patient Access regulation?
Table of Contents
What Is Interoperability?
Interoperability describes the ability of systems and software to exchange data without great difficulty or disruption. Interoperability is key for healthcare providers as different hospital systems have different electronic health record (EHR) vendors and integrated services. Without interoperable EHRs, care coordination and diagnostic accuracy would become a challenge for healthcare providers and the quality of care would suffer.
The new Interoperability and Patient Access final rule should address these challenges head on and make sure that patients and their doctors have access to medical data—in a form that is practical, useable, secure, and easily shared—no matter what EHR platform is used to manage it. Overall, it will support the goal of facilitating data exchange by bringing more visibility and standardization to practices throughout the healthcare industry. The end benefits of seamless interoperability are numerous:
- Patients are empowered to choose the best healthcare options for themselves and their family.
- Privacy and security are protected at every point of data transmission and access.
- Medical providers can work more efficiently and deliver care in a timely fashion.
- Patient care is more accurate with comprehensive patient records and it will reduce the risk of duplicate tests and the risk of dangerous drug interactions.
- It helps healthcare providers to reduce costs.
- Insurance and payment information is readily available.
How the Federal Interoperability and Patient Access Rule Will Affect Patients
One of the critical issues in healthcare today is that patients cannot easily access their medical information in an interoperable form. CMS believes that patients should be able to see insurance, clinical, and administrative health information all in one place. With that, patients will be better able to move from payer to payer, and from provider to provider.Together with the ONC’s 21st Century Cures Act, the CMS’s rule aims to empower patients to make better decisions and inform providers in support of better medical outcomes.
Insurance companies and healthcare payers are now required to give patients access to their claims, treatment information, and treatment costs. Patients will be able to see this information thanks to third-party applications, such as EMR vendors, that connect the NPI directory to digital records held by providers.
How the Interoperability and Patient Access Rule Will Affect Healthcare
This innovative rule is designed for payers, providers-including everything from individual practitioners to hospitals, as well as vendors in the healthcare industry.
Standardized Data Format
We can all agree that having up-to-date, accurate primary care provider and care team information at the point of care is vital. With this new federal mandate, essentially, any provider, application or researcher selected by the patient or caregiver will have access that to all his/her medical history in a standard format that is commonly accepted and used across the healthcare system.
Timely Access to Data
Starting from January 2021, patients must be able to receive the information requested within one business day of their request or when a claim is adjusted. The Interoperability and Patient Access ****rule is retroactive; so data dating back to January 1, 2016 must be available. To facilitate patient access, insurance providers and payers will need to provide a secure portal where they can login to request and review the data needed.
Secure Data Sharing
Providers and hospitals are responsible for building out their electronic medical record and health information exchange environments in compliance with the final rule. IT staff and service providers need to develop, test, and implement changes to software and API connections to allow data to be exchanged in a secure and standardized way.
Since the start of 2021, CMS-regulated payers, such as Medicare Advantage and CHIP, are required to make provider directory information publicly. Utilizing an application programming interface that meets the Fast Healthcare Interoperability Resources standard (FHIR API for short) will be necessary to support secure data exchange and prior authorization.
Business Operations
Interoperability and Patient Access final rule means that changes to business policies, practices, and security controls will need to be made. Delivering the information requested in the required time frame, one business day, may have a significant impact on how payers and providers operate.
Reporting Compliance
CMS plans to enforce this new measure against information blocking in a number of ways. This includes publicly reporting which clinicians and healthcare professionals have systems that may interfere with the access, exchange, or use of electronic health information. Additionally, CMS will publicly report on physicians and hospitals that do not participate in the National Plan and Provider Enumeration System (NPPES) by keeping their contact information updated in the digital directory.
This means that compliance efforts will need to be modified and health systems need to ensure that they have the technology in place to meet these new regulations.
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