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new federal rules on interoperability and patient access

As if 2020 couldn’t be any more challenging for healthcare providers, new federal rules on interoperability and patient access, granting patients direct access to their healthcare data, begin taking effect in 2021 and will continue into 2022. These rules, while ultimately beneficial to patients, bring an additional level of operational complexity to many revenue-stressed healthcare organizations.

If anything, the 2020 pandemic has illustrated the vast potential of interoperability. For example, consider the huge increase in 2020 in virtual care visits, projected to be more than 1 billion by year’s end, and with an estimated 90% related to Covid-19. Many of these new virtual health patients will move through different care networks, using different health plans, and seeking remote access to their health records. These are precisely the type of patients interoperability is meant to help.

What should healthcare providers be doing now to ensure they’re not only compliant with new interoperability rules, but also applying them as optimally as possible to benefit their patients and organizations? In this article, we review the upcoming rules and suggest five key steps providers can take to ensure their interoperability implementations proceed as smoothly as possible.

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What’s Ahead with Interoperability? 

After several years of discussion on interoperability standards, the Office of the National Coordinator (ONC) for Healthcare IT and the Centers for Medicare & Medicaid Services (CMS) issued their final rules on interoperability in the spring of 2020. The new rules, covering both health systems and health plans, are intended to ensure that patients can electronically access their healthcare information regardless of health system or type of electronic health records (EHR) and covering all CMS-regulated plan types, including Medicare Advantage, CHIP, and the Federally Facilitated Exchanges.

Starting April 5, 2021, healthcare systems must begin complying with interoperability rules preventing information blocking, which means not interfering with patients’ access to or use of their electronic health information. Providers must also attest they are acting “in good faith” regarding preventing information blocking, with any non-compliance flagged on the National Plan and Provider Enumeration System. By May 1, 2021, hospitals, psychiatric hospitals, and critical access hospitals with an EHR must send notification of their patients’ admission, discharge, and transfer (ADT) events to providers.   Interoperability will replace the current fragmented and error-prone ways of exchanging vital healthcare information. Near-term benefits of interoperability include improved care coordination and patient experience, greater patient safety, and stronger patient privacy and security. Longer-term benefits include higher provider productivity, reduced healthcare costs, and more accurate public health data.

5 Steps for Interoperability Excellence for Healthcare Providers

For providers, the good news about interoperability is that they’ve had years to think about and implement many of its fundamental tenets, based on their work meeting meaningful use requirements. That’s borne out in a 2019 HIMSS survey of healthcare organizations which found nearly 75% of respondents past the “foundational” level of interoperability – “foundational” defined as allowing data exchange from one IT system to another, but without data interpretation.

Five Steps for Interoperability Excellence 

While healthcare systems will achieve significant interoperability gains through technology investments, they should not consider technology as the ultimate sole key to interoperability success. If anything, financial and political considerations may be far more important to your organization’s interoperability success. Here are five critical non-technology factors to consider:

1. Determine your “master” interoperability strategy

All pertinent stakeholders in your organization should be on the same page about your interoperability strategy, resources, and timing. Know up-front that those implementing interoperability may not have previously worked with patient-centric analytics, partners, or departments in your organization. Plan your resources and timing accordingly. Your strategy should focus on the value-add of interoperability internally, such as access to additional data points on your patients, and externally, such as how you describe the upcoming benefits of interoperability to your patients.

2. Convey your vision, expectations and expected return

An interoperability implementation is a massive change management initiative, which requires continuous, top-down leadership and championship, and proper expectation-setting. Communicate where your organization currently stands regarding its interoperability capabilities, and where you wish to have it go. Convey how the organization plans to get to its future desired state. And perhaps most importantly, share the likely return on investment in this effort. Be as specific as possible. For example, if you believe interoperability gains will ultimately enable a 5% decrease in your hospital readmissions, state that.

3. Examine workflows and identify specific use cases

Every type of ADT event in your organization, and its corresponding workflows and system interactions, should be under review. Consider all types of clinical use cases, the types of data to be exchanged, and those involved in providing patient care. This will help determine your optimal approach to data-sharing and how your organization can strategically use the additional data you receive from other health systems.

4. Rigorously prep your data

Standardized data collection and reporting which produces quality data is the heart and soul of successful interoperability. Be sure your organization’s data is clean and meaningful, and will ultimately be understandable and useful to your patients.

5. Think big-picture differentiation

There’s nothing in the ONC and CMS interoperability rules that says you need to stop at mere rules compliance. Consider your pursuit of interoperability as a singular opportunity to be a patient-centric leader in your market. Let everyone relevant know of the success you’ve achieved.

While interoperability offers a chance for healthcare systems to achieve multiple operational gains, when handled well, it is ultimately a patient-centric endeavor. Always keep the needs and interests of your patients at the core when facilitating access to their personal health data. It’s the ultimate smart long-term interoperability strategy.

Sandesh Ilhe
Sandesh Ilhe
With an Engineers degree in Advanced Database Management and Information Security, Sandesh brings the deep understanding of the digital world to the table. His articles reflect the challenges and the complexities that come along with every disruption in the industry. He carries over six years of experience on working with websites and ensuring that the right article reaches the right reader.