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2021: The Year of the CMS Interoperability and Patient Access Final Rule

doctor reviews a patient's medical data on a tablet

In my many years practicing as an emergency room nurse, I faced questions of how to get patient records from outside facilities daily as patients would walk, get wheeled in, or sometimes even carried through the door. For the subset of patients who were unable to communicate, the risk of giving them a medication that they might be allergic to, or giving a treatment that might have adverse effects, was magnified further.

Subsequently, in my time as a hospital administrator, I found that patients were at risk of getting repeat tests and experiencing delays in care while we worked to get access to outside records and coordinate care across networks. There was no question in my mind that better access, portability, and interoperability of records could dramatically make a difference, improving care and the lives of the patients that came through our doors. Moving into health IT roles, I couldn’t ignore the complexities of the problem, with lack of standardization, mountains of duplication and inconsistent information the norm.

True interoperability provides clean, deduplicated and shared data along with a full longitudinal view of the unified care record that can be accessed anywhere at any time. It is foundational to ensure the best possible care for a patient across the entire care continuum. In short, it saves time – and lives.

This level of interoperability has been an overarching goal of the U.S. healthcare industry since the implementation of the HITECH (Health Information Technology for Economic and Clinical Health) Act in 2009. The intent of this act was to stimulate the adoption of electronic health records (EHR) and the supporting technology in the United States, while improving the safety, quality, and efficiency of patient care. However, more than a decade since the HITECH Act passed, healthcare interoperability has yet to be fully realized in the U.S.

As a Clinical Product Manager at InterSystems, I work with clinicians to define the best way to surface patients’ aggregated records to give them the information they need, when they need it, for improved delivery of care. My experience in health systems not only demonstrated to me the crucial need for greater interoperability standards across the U.S. healthcare system, but also the positive difference that clean and aggregated health information can have on patient care. Regulations released in 2020 further this work.

In January 2021, the first requirements of the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access final rule (9115-F) go into effect— a new set of federal guidelines that grants patients increased access to their health information and improves interoperability while reducing the burden on payers and providers.

With implementation guides still being finalized, meeting these new requirements may not be a straightforward and easy process for payers and providers. As such, we are excited to announce our HealthShare® CMS Solution Pack™, designed to address the challenges associated with meeting the new federal requirements and how they will impact patients, providers, and payers.

The HealthShare CMS Solution Pack enables payers to share required claims, clinical and pharmacy benefit data, regardless of its format, and transform it into FHIR 4.0.1 representations for easy patient access. Additionally, the bundled solution enables providers to coordinate care through the easy exchange of patient information and alerts as they transition between settings of care.

Clinicians shouldn’t need to worry about the logistical aspects of the new regulations and should instead be excited for what they mean for the industry. Our customers will be able to ensure their end-users are equipped with the technology they need to do their jobs to the best of their ability.

InterSystems will share additional insights into how we are helping to address the challenges of healthcare during this year’s Virtual Global Summit October 20 – November 5. Join us to learn how InterSystems partners around the world are sharing information for better health and care.
Have you registered for InterSystems Virtual Summit 2020 yet? Registration is OPEN and FREE!


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