What the New Proposed Interoperability Rules Mean for Providers: A Look at Next Generation Data Sharing

On the eve of HIMSS19, CMS released a long awaited proposed policy package on interoperability and data-sharing, virtually guaranteeing that the announcement would be a top news item at the conference and into the spring. Through these proposals, CMS is doubling down on its goals of empowering patients and improving care coordination. Patients would get access to their medical information in a standardized format that would allow it to easily travel with them across the entire patient journey. Payers would be responsible for supporting this electronic health data exchange, as well as for adopting technology to make their provider networks more readily available. Providers would be significantly impacted as well, with the proposed interoperability rule making it mandatory for hospitals to share ADT (admissions, discharge, and transfer) data electronically as part of the Conditions of Participations for Medicare. This post will discuss the context in which the proposed rules were released, highlight the benefits and challenges around the release of health data, and explain how CMS’ overall approach will promote industry innovation and technology solutions that support a variety of data use cases.

Interoperability: A Key Component of Value-Based Care

CMS’ proposal comes at a time of ongoing regulatory and reimbursement changes in the healthcare industry. The rise of Medicare Advantage, Medicaid managed plans, and other managed entities have created strong market incentives for providers to prioritize interoperability. Value-based reimbursement further supplants fee-for-service each year, and there’s really no way for health systems to succeed in risk-based arrangements without building infrastructure to facilitate data sharing between providers in different care settings. How else can they track and monitor patients as they transition to different levels of care? These arrangements depend on providers being able to intervene to keep their patients on the path to good health. Providers have a lot of competing priorities, however, so the push from CMS, especially if penalties for information-blocking make it into the final rules, may be just what’s needed to drive change and ensure that interoperability is prioritized. Additionally, the benefit of CMS setting up a framework for interoperability is that it will establish which technology approaches and platforms are most effective in the world of value-based care.

The Benefits of Data Sharing

As mentioned, the proposed rule requires hospitals to make ADT data available electronically. That means that ADT information will need to go out for every inpatient stay. In theory, this will be welcome news to providers on the receiving end. With these alerts, for example, a skilled nursing facility would know if a patient has been readmitted to the hospital. Under new government programs like the SNF Value-Based Purchasing Program, SNFs are going to be held responsible when their patients are readmitted to the hospital within a certain timeframe. The ADT information could help facilities monitor patients and trends. Another example is PCPs. Physicians would benefit from knowing when one of their patients has been discharged from the hospital so that they can reach out and set up a follow-up appointment in the office.

The Challenges of Data Sharing

But there will also be real challenges for providers receiving data. How useful, after all, is a pure data dump? How many providers have resources available to sift through the slew of alerts that would be coming just from this ADT requirement? To actually impact health outcomes and improve continuity of care for patients, the data being shared needs to come in to organizations in some kind of organized way, and it also needs to be actionable. Going back to the above example, the SNF needs to know why their patient was readmitted. If the readmission was preventable, they’re at fault, but if it wasn’t, they’re off the hook. And for the PCP, it’s not enough to know that their patient was hospitalized. They also need information about any new diagnoses and medications to do effective follow-up care. This is where healthcare technology vendors can really demonstrate their worth, by taking these massive bundles of patient alerts and unlocking the value of the data to make it more prescriptive and predictive.

An EHR-Agnostic Approach That Will Fuel Innovation

By focusing on APIs and standard data formats, as CMS has done with these proposals, the agency acknowledges that there is no one-size-fits-all approach to interoperability and data sharing. CMS’ approach ensures that data can be used in many different ways and also recognizes the need for flexibility in building connections between EHRs. Making healthcare data available across a variety of technology platforms and applications sets the industry up for use cases we can’t even imagine today and promotes innovation among healthcare technology vendors. At CarePort, we’ve gone to great lengths to create user-friendly interfaces and develop EHR-agnostic solutions that add data analytics value without interrupting providers’ existing workflows. We want to be sure that data can be accessed in a way that supports a wide range of use cases, and from the proposed rules, it’s evident that we are aligned with CMS’ goals.

The Long and Short of It All

Value-based care is becoming the new normal, and it requires providers across the continuum to invest in infrastructure that breaks down silos between organizations. Regardless of what makes it into CMS’ final rules, and what comes out of the RFIs released with the new policy proposals, this is work that needs to be done. The future of healthcare lies in connecting the continuum, because that’s ultimately what is needed to improve the patient experience and provide more coordinated care. While this post has focused on providers, it’s important to never lose sight of the patient.

Learn more about how to overcome silos of patient information and connect providers with real-time, actionable data.