Healthcare Legislation

Policy Updates Can Pave the Way to Interoperable Healthcare IT in 2021

While the COVID-19 pandemic pushed many interoperability and data liquidity conversations in legislatures to the backseat in 2020, they return in 2021. With rule implementation looming, the stage is set for improved transparency and choice for providers and patients.

Nick Anderson
Nick AndersonDirector of Product Management, Provider
March 10th, 2021
A nurse walking down the hall while looking at her iPad

Healthcare IT lags behind other industries on improving consumer engagement. Some estimate by 10 years.Independent Study Commissioned by Virtusa Finds 85 Percent of Businesses Plan to Invest in Digital Transformation in 2018, Businesswire, 2018 While the capability and appetite for innovation exists, implementing these solutions usually hits friction in the form of regulatory requirements and legislative red tape. But recent healthcare IT legislation and demonstrated success from relaxed policies due to the COVID-19 pandemic have the potential to open greater access to healthcare data sharing and patient choice.

The new legislation aims to improve data liquidity, the continued use of data entered in a system by other systems or users, and interoperability — the ability for two systems to communicate and work together. The ONC 21st Century Cures Act Final Rule and the CMS Interoperability and Patient Access Final Rule will have successive pieces implemented in the healthcare ecosystem over the next three years.

Coupled with new widespread use of telehealth platforms, with year-over-year visits still up by over 2,000 percent, and proposed legislation on point-of-prescribing price transparency, healthcare stands to gain much-needed innovation in the consumer engagement field.Monitoring the Impact of COVID-19 on the U.S. Pharmaceutical Market, IQVIA, 2021

Let's talk about data liquidity and interoperability

As consumers, we can manage our bank accounts via smartphones and complete a mortgage process digitally, but we can’t easily send our medical records across the street. Patients often express frustration from ferrying lab results, diagnoses, medication records and vital histories from one provider to another, especially if they’re managing a chronic condition.

In a recent study from Pew Trusts:Americans Want Federal Government to Make Sharing Electronic Health Data Easier, Pew Trusts, 2020

  • 61 percent of participants said they want to be able to manage their own health by downloading their health records to applications on mobile devices.
  • 81 percent said they'd support enabling different healthcare providers to share patient health record information between their Electronic Health Records (EHR) systems when caring for the same patient.
  • 87 percent said they want to be able to electronically access imaging data, such as CT scans and X-rays in their EHR.

That’s where data liquidity comes in.

Data liquidity describes the ability for a single data point to flow unimpeded throughout and among systems in healthcare. Instead of that one data point needing to be entered multiple times by multiple care teams, data liquidity allows that piece of data to travel freely among EHRs. Improved data liquidity reduces the burden on patients to give their relevant health data to providers and pharmacists. It also reduces the burden for providers and care team members, especially when surfacing benefit information for patients.

Three-fourths of nurses surveyed said they look for medication and coverage information in multiple places because it’s not located in one source.CoverMyMeds Nurse Survey, 2019 And 43 percent of pharmacists surveyed said they go outside their system to complete day-to-day tasks, including discussing patient coverage or affordability issues.CoverMyMeds Pharmacist Survey, 2020

Interoperable systems can help make better data liquidity a reality. Interoperability describes systems’ ability to exchange information and work together seamlessly. This concept is an increasingly critical piece of the healthcare IT puzzle, as new technologies continue to blur the lines of the traditional healthcare systems. It’s also important for the 85 percent of providers who started telehealth for the first time in 2020 — likely with newly adopted technologies.[ref](# CoverMyMeds COVID-19 Provider Survey, 2020") The more data available within workflow, the better for these providers who are practicing both in-person and through a screen.

Newly introduced policies specifically name interoperability in their titles, providing a clear priority for healthcare’s future.

Healthcare interoperabilty policy for a new year

On March 9, 2020, the Office of the National Coordinator (ONC) for Health Information Technology and Centers for Medicare and Medicaid Services (CMS) released twin policies that set the tone for the future of healthcare access and interoperability.

The ONC 21st Century Cures Act Final Rule implements the interoperability and information-blocking sections of the 21st Century Cures Act, a broader piece of bipartisan healthcare legislation passed in 2016.ONC Cures Act Final Rule, Office of the National Coordinator, 2020

The CMS Interoperability and Patient Access Final Rule provides CMS-regulated payers with specific guidance for privacy, security and standards related to data exchange, information blocking and patient access to their health data.Policies and Technology for Interoperability and Burden Reduction, Centers for Medicare and Medicaid, 2020

Unlike the Health Insurance Portability and Accountability Act (HIPAA), which safeguards protected health information from being shared or received unless authorized, the two final rules specifically prioritize electronic health information (EHI) sharing, especially with patients, with certain defined exceptions.

When Congress passed HIPAA in 1996, electronic health information was in its infancy and the first smartphone was 12 years away. In today’s world of wearable health trackers and social media, we often manage our health outside the traditional healthcare systems.

These final rules require using open application programming interface (API), specifically on HL7’s Fast Healthcare Interoperability Resource (FHIR). This move modernizes healthcare data exchange standards to allow healthcare developers freedom for innovation while maintaining a common set of data so solutions can communicate. A FHIR-based API system will allow hospitals, providers and health systems to not only select the apps and EHRs that best suit them, but also allow easier data exchange.

This helps remove the information-sharing burden from patients, especially those who visit multiple providers. It also relieves the provider burden: 55 percent of providers with patients on complex therapies said electronic communication to other healthcare parties would exist in their ideal tool.CoverMyMeds Provider Survey, 2020

Under the new CMS rules, patients have access to their electronic claims and plan design data even through third-party apps. Certainly, this raises privacy concerns, as HIPAA doesn’t regulate these apps. Patient privacy education, and potentially further-reaching state legislation, may increase in the future to address these concerns.

Within these rules, providers, patients and health systems have more freedom of choice regarding technology selection and personalization, without fear of data loss or information blocking. Patients can switch payers and rest assured their relevant health information will flow to their new payer. Providers can switch EHRs and know they’ll be able to access patient information and clinical notes in a familiar format.CMS Finalizes New Interoperability Rule for QHP, Other Insurers, Health Affairs, 2020

Upcoming legislation and patient affordability implications

Though data channels are opening and patient access is improving, many healthcare IT challenges await. While the CMS Final Rule addresses payer-related data transparency, state legislation will likely be needed to address similar policies for commercial plans.

On medication access, patients consistently say paying the lowest price is the most important factor.CoverMyMeds Patient Survey, 2019 But knowing the lowest price isn’t always easy for patients or providers. Many states are addressing price transparency at the point of prescribing, making this information more accessible for providers in real-time within their workflow.

__To read more about medication access policy, look for our upcoming Medication Access Report addition on legislation and regulation. Find the full Medication Access Report here. __

Nick Anderson
Nick AndersonDirector of Product Management, Provider

Nick works to bring new technologies focused on improving the prescribing process and patient adherence to market.

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