Individuals around the world have visited hospitals, clinics, and other medical centers at some point during their lives. As a result, they often need to provide their healthcare information in the course of their visits. This brings us to the problem.
Consider these common issues faced by patients:
The answers to these are often a resounding “no”. Currently, all medical intuitions store/own all their patients’ health records. However, as this information currently resides in silos, it is of no value to patients themselves.
Now, consider the following. What if:
If this sounds too good to be true, it's not. This is where Interoperability in Healthcare comes in. This is not just about being compliant with the US Centers for Medicare & Medicaid Services (CMS) regulations. This is about transforming the industry. However, interoperability can be risky as security and privacy must be present as the information is extremely sensitive. Having the right balance between interoperability, security, and privacy will lead the way towards Digital Healthcare Innovation. This is shown by Figure 1.
Figure 1: Digital Healthcare Innovation = Interoperability + Security & Privacy
This leads us to the solution.
As part of the Trump administration’s “MyHealthEData” initiative, the Interoperability and Patient Access final rule (CMS-9115-F) was introduced. This focuses on driving interoperability and patient access to health information by liberating patient data using CMS authority to regulate certain health plan issuers.
As part of this rule, the US government introduced new policies that give patients access to their health information and move the healthcare system toward greater interoperability. These new policies are the Provider Directory API policy, Patient Access API policy, and Payer-to-Payer Data Exchange policy, which are illustrated by Figure 2 below.
Figure 2: CMS-9115-F regulations and timelines | Source: WSO2
As a result, insurance providers, hospitals, pharmaceuticals, medical equipment providers, and other institutions that deal with patient and other healthcare information, must adhere to the above policies. This interoperability aims to provide patients with a seamless, integrated experience in the healthcare industry.
While CMS-9115-F (CMS in short) looks promising for patients, it causes multiple challenges to other stakeholders as shown below.
As such, there is plenty to be done to become CMS compliant. Stakeholders in healthcare will require a team of engineers and a set of products to build a solution to cater to these interoperability, privacy, and security requirements. These are shown by Figure 3, and involve:
Figure 3: Challenges faced in Healthcare Interoperability
In our next article, we will focus on how these open healthcare systems enable interoperability.