CMS interoperability rule becomes enforced June 30: 6 things to know

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HHS and CMS' regulations requiring all healthcare providers and payers to meet interoperability standards will start being enforced on June 30.

The rule is the first phase of policies aimed at advancing interoperability and patients' access to their health information. The rule is designed to break down barriers that prevent patients from getting electronic access to their health information and taking a step toward interoperability and patient data exchange.

Six things to know:

  1. The final rule was launched Jan. 1, but enforcement of the rule was put off because of the pandemic. It will enable patients to access their health information electronically without special efforts. Payers subject to the rule will be required to make data available through application programming interfaces, to make accessing health data easier for patients. 

  2. APIs must make adjudicated claims, provider encounters and clinical data available no more than one business day after a claim is adjudicated or a patient encounters a provider. API standards are still being finalized to ensure the security of patient data.

  3. Hospitals that use EHR systems must demonstrate they can comply with federal data exchange standards. For example, a hospital must show its system can produce an electronic patient event notification when a patient is admitted or discharged.

  4. CMS' Interoperability and Patient Access final rule requires CMS-regulated payers to implement and maintain an HL7 Fast Healthcare Interoperability Resources standard API, referred to as the Patient Access API.

  5. ONC's final rule targets necessary activities that do not constitute information-blocking and establishes new regulations to prevent information-blocking practices by providers, health IT developers, health information exchanges and health information networks. The rule also aims to give patients more access to their health information via smartphone apps of their choice.

  6. HHS and CMS are working with ONC to create clear objectives for improving patient access, mitigating provider burnout and reducing healthcare costs. Healthcare costs will be cut down because improved interoperability will minimize the need for duplicate testing, among other inefficiencies.

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