Interoperability Rules Primer: Stakeholders’ Key Concerns as Final Regulations Set to Drop

It’s been nearly a year since federal officials stunned the healthcare and health IT community with two proposed rules on interoperability and patient access during the week of HIMSS19. Now, we’re just weeks—or perhaps even days—away from the final versions of these regulations. What are the key considerations for stakeholders to keep in mind as they await for the rules to drop?

For some background, the proposals—one from the Office of the National Coordinator for Health IT (ONC) and one from the Centers for Medicare & Medicaid Services (CMS)—were separate, but at the same time very much aligned. Broadly, the two proposals—about 1,200 pages combined—look to further advance the nation’s healthcare interoperability progress. They represent great significance for health IT stakeholders, who will now be more under the microscope than ever before as it relates to their efforts in making sure that health information is seamlessly moving—while not restricting such efforts.

For example, key elements of the ONC rule are related to application programming interface (API) standards, electronic health record (EHR) certification, and EHR vendor business practices and behaviors. It also has a significant section devoted to information blocking with potentially hefty fines for violators.

The CMS rule, meanwhile, proposes a mandate that would require all Medicare Advantage (MA) organizations, state Medicaid and CHIP fee-for-service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and QHP (qualified health plan) issuers in FFEs (federally-facilitated exchanges) to ensure that patient claims and other health information are available to patients through third-party applications and developers by 2020. The rule also proposes that payers in CMS programs be required to participate in a health information network of their choosing.