In 2018, the Centers for Medicare and Medicaid Services, the Office of the National Coordinator for Health IT, and the White House Office of American Innovation, publicly announced the commitment to ensuring that patients would have access to their healthcare data wherever and whenever they need it, and also commenced on a journey to break down the barriers that keep critical patient health information locked in digital silos.
- For decades, the path to healthcare interoperability has been a relay spanning multiple administrations, one in which each administration has passed the baton to the next, moving the healthcare industry closer to the goal, but always falling short of seamless interoperability of health data.
- In May 2020, CMS finalized the first rule dedicated to interoperability with the CMS Interoperability and Patient Access final rule. Based on Medicare’s Blue Button initiative that provided claims data to patients, the final rule focused on driving interoperability and patient access to health information by liberating claims and clinical data for 85 million patients.
- At the same time, ONC finalized their 21st Century Cures Act final rule, which will support patient access to their electronic medical records directly from their providers through FHIR-standards-based APIs. Together, these rules addressed both technical and healthcare industry factors that cause barriers to the secure exchange of health information and limit the ability of patients to access essential health information.
- Finally, the proposed rule would tackle one of the foremost challenges for providers, payers, and patients alike: effective prior authorization. Prior authorization is an administrative process for providers to request confirmation from payers that the providers will be paid for a medical service, prescription, or supply.
- Technology is ever-evolving, and the work will constantly evolve, but the efforts have laid a foundation for future policy that will enable the secure and interoperable exchange of healthcare information, drive value-based care in America, and give patients and doctors the information they need.