Healthcare has witnessed remarkable changes recently, largely driven by digital technology. A key manifestation of this transformation is healthcare interoperability. This breakthrough is key to improving patient care and optimizing healthcare operations. The Centers for Medicare & Medicaid Services (CMS) has been instrumental in driving these changes.
In this blog, we’ll discuss CMS’s role in advancing healthcare interoperability and how these efforts are reshaping healthcare across the nation.
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The Role of CMS in Healthcare Interoperability
CMS, the U.S. government agency responsible for overseeing Medicare and Medicaid, has long recognized the importance of interoperability in improving healthcare outcomes. While private-sector initiatives like EHR adoption and data exchange standards have paved the way, CMS has played an important role in shaping federal policies and promoting interoperability across the healthcare landscape. Over the years, the agency has implemented several reforms to improve data sharing, enhance patient access to health information, and reduce administrative burdens.
Key Milestones in How CMS Helped Achieved Healthcare Interoperability
1. The Medicare and Medicaid EHR Incentive Program (Meaningful Use)
In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed, and it laid the foundation for the meaningful use of electronic health records. The Medicare and Medicaid EHR Incentive Program encouraged healthcare providers to adopt certified EHR technology (CEHRT) and demonstrate its meaningful use by meeting specific objectives and measures, which included interoperability and patient engagement.
While the program incentivized the adoption of EHRs, it also established interoperability as a fundamental pillar of meaningful use. By setting interoperability as a core requirement for meaningful use, CMS helped stimulate the development of healthcare information exchange platforms. Later, these platforms became critical in making patient data accessible across different settings of care.
2. The 21st Century Cures Act
The 21st Century Cures Act, passed in 2016, was one key legislative action in advancing healthcare interoperability. This law introduced several provisions to address healthcare data sharing and improve interoperability. Among its most impactful provisions was the information blocking rule, which prohibited healthcare organizations and IT vendors from blocking the sharing of patient data for any unjustified reason.
The Cures Act emphasized the need for application programming interfaces (APIs) and other technical standards to make it easier for patients and healthcare providers to access and share data. CMS played a key role in implementing and enforcing the Cures Act, which shaped the future of interoperability. The agency pushed for adopting standards like FHIR (Fast Healthcare Interoperability Resources), a flexible, open standard for exchanging healthcare information electronically. This initiative has allowed developers to create apps that give patients direct access to their health records, enhancing patient engagement.
AERIS, a FHIR-based platform, transforms real-time clinical data exchange by connecting different healthcare systems. Using HL7 FHIR standards, AERIS makes it easy and secure for healthcare providers, payers, and other stakeholders to share clinical data.
3. The CMS Interoperability and Patient Access Rule
In 2020, CMS took another major step forward with the Interoperability and Patient Access Rule, which aimed to improve healthcare data exchange between payers, providers, and patients. This rule requires health insurers to give patients electronic access to their claims and clinical data via APIs. It also mandates that health plans make patient data available in a standardized format, which can be easily integrated with EHRs and other healthcare systems.
For the first time, the rule provided a clear framework for the healthcare industry to enable patients to access their health data whenever they want, regardless of the system or platform in use. This initiative empowers patients, providing them with more control over their health information and the ability to share it seamlessly with different providers and facilities.
4. The Role of CMS in Promoting FHIR Standard Adoption
FHIR, a modern healthcare data exchange standard, has emerged as a key enabler of healthcare interoperability. CMS has advocated for FHIR as a foundation for interoperability, and in 2021, it officially included FHIR standards in its reporting and data-sharing requirements for health plans under the Patient Protection and Affordable Care Act (ACA).
By promoting FHIR, CMS has facilitated the development of digital health tools that make patient data more portable and accessible. Now, providers can easily share patient information with different entities, such as specialists, hospitals, and pharmacies. This significantly improved care coordination and reduced gaps in care, as healthcare professionals have access to the most up-to-date information at all times.
5. The Push for Public Reporting and Data Transparency
To further enhance healthcare interoperability, CMS also pushed for greater data transparency. By demanding that healthcare organisations publicly report performance data related to quality, cost, and patient outcomes, CMS has created a culture of openness in the industry. This transparency has forced healthcare providers to adopt interoperable systems that can track, share, and report on data efficiently.
Because CMS focuses on public reporting, organisations have been motivated to improve their data-sharing capabilities. When healthcare providers can access data in real-time and share it easily with other organisations, they can make more informed decisions that lead to better patient outcomes.
6. Promoting Collaboration with Private Sector
CMS recognises that achieving full healthcare interoperability requires collaboration between the public and private sectors. As a result, the agency has worked with various stakeholders, including private payers, technology companies, and healthcare providers, to encourage the adoption of interoperable solutions.
In 2019, CMS collaborated with the Office of the National Coordinator for Health IT (ONC) to release the Shared Nationwide Interoperability Roadmap, which outlined the goals and steps needed to achieve nationwide healthcare interoperability. This roadmap emphasised the need for open standards, common data models, and streamlined data exchange protocols across the entire healthcare ecosystem.
The Future of Healthcare Interoperability
Looking ahead, CMS’s continued efforts to promote healthcare interoperability will likely result in even more significant advancements in the coming years. With the increasing emphasis on patient-centred care, data-driven decision-making, and value-based care models, the need for seamless healthcare data exchange will only grow. As CMS continues to refine its policies and collaborate with industry leaders, the goal of a fully interoperable healthcare system seems increasingly achievable.
Discover how AERIS can transform your clinical workflows and improve patient care. Contact us today!
FAQs
1. How did CMS contribute to healthcare interoperability through the Medicare and Medicaid EHR Incentive Program?
The Medicare and Medicaid EHR Incentive Program, under the HITECH Act, encouraged healthcare providers to adopt electronic health records (EHRs) and meet specific interoperability standards. This program helped establish interoperability as a core requirement and facilitated the development of health information exchange platforms.
2. What role did the 21st Century Cures Act play in advancing healthcare interoperability?
The 21st Century Cures Act, passed in 2016, introduced provisions that targeted healthcare data sharing and interoperability. A major element was the information blocking rule, which prohibited healthcare organizations from unjustifiably blocking data exchange. The law also promoted the adoption of standards like FHIR to improve data accessibility and patient engagement.
3. How does FHIR support healthcare interoperability, and what role does CMS play in its adoption?
FHIR (Fast Healthcare Interoperability Resources) is a standard for exchanging healthcare data electronically. CMS has advocated for its adoption by integrating it into its data-sharing requirements for health plans under the Affordable Care Act. This has enabled more efficient data sharing and improved care coordination between healthcare providers.
4. Why is collaboration with the private sector important for healthcare interoperability?
Achieving full healthcare interoperability requires collaboration between both public and private sectors. CMS has worked with various stakeholders, such as private payers and technology companies, to encourage the development of interoperable solutions, ensuring a more seamless and efficient healthcare data exchange ecosystem.
