The infrastructure needed to meet health interoperability needs

Kristen Ballantine, Vice President of Government Relations at Gainwell

For most patients, it has always been extremely difficult to transmit their personal health and medical data electronically. However, with the CMS Interoperability and Final Patient Access Ruleconsumers, especially Medicaid members, there is greater pressure to provide access to and ownership of this data.

With this move towards interoperability comes new requirements that healthcare organizations must meet and adhere to under the rule. To meet many of these federal interoperability requirements, and ultimately fulfill the promise of interoperability, healthcare organizations must implement specific application programming interfaces (APIs) to transfer the data that ‘they store in-house and create the technical infrastructure needed to support consumer-facing applications.

With these pillars of technology and infrastructure in mind, healthcare organizations will be able to provide consumers with the data they need and meet new federal standards.

Keys to a Successful Interoperability Ecosystem

First and foremost, it is enough to access the data itself. Recent federal guidelines give healthcare organizations the ability to use tools to support consumer-facing apps and portals to deliver data to patients, which means healthcare organizations must be able to provide this data to consumers. Implementing specified APIs can help in accessing necessary information, such information being claim data, clinical information, form data, etc. Multiple, often disparate systems, such as Medicaid Enterprise Systems (MES), immunization registries, health information exchanges, and pharmacy benefit management systems contain all the data consumers want and need. to access. Once this data is obtained, previously inaccessible information must be loaded into a Fast Healthcare Interoperability Resources (FHIR) repository.

By taking data from source systems, organizations can map that data into the FHIR format and once it has been loaded into an FHIR data repository, the data can then be published into the required API format. After all the reformatting, consumer-facing apps and portals can access these APIs from the data repository to collect the information they want and need, and then turn the data into personalized healthcare insights for consumers.

It is crucial that security measures are in place while increasing data availability. To ensure that APIs disclose this sensitive data to the right people in a secure and HIPPA-compliant manner, organizations must rely on third-party vendors and their supporting solutions. Through partners and external technology solutions, organizations can provide consent management by leveraging things like compliance monitoring and comprehensive security services, which include virus and vulnerability scans and testing. penetration, to reduce any potential breach of security. Due to the complex nature of Medicaid organizations, lack of existing member portals with member usernames or passwords, and complicated patient relationships, managing consent can also be a challenge. Organizations, especially Medicaid organizations, should strategically use industry-leading vendors and solutions to address these challenges to prioritize authentication to mitigate potential security issues.

In addition to accessing and securing data, an ecosystem of third-party developers is also necessary for interoperability. Healthcare organizations must register app developers and give them access to API endpoints. With the help of patient access and interoperability solutions, third-party application developers can perform end-to-end testing with APIs, while being tested in a safe environment. Although API support for interoperability can be difficult to navigate due to multiple stakeholders, coordination between consumers, third-party developers, and API developers may still be required.

Meet federal standards

Until recently, patients had little or no visibility into their personal medical data due to a disparate and siled ecosystem. Now that the CMS Patient Access and Interoperability Final Rule has put in place a structure and timeline for how we actually achieve interoperability, it is up to healthcare organizations to meet new federal standards and to deliver on the promise of interoperability – starting with data transformation to develop and release Apis. Interoperability represents a fundamental shift that puts consumers in control of their healthcare journeys, and healthcare organizations must evolve to support this movement.

About Kristin Ballantine

Kristen Ballentine is Vice President of Government Relations at Gainwell Technologya health technology company focused on improving public health outcomes, where she oversees Gainwell’s state and federal legislative, policy and regulatory programs.

About Cedric Lloyd

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