From the September 2022 issue of HealthCare Business News magazine
These uncertainties are compromising compliance, compounding the challenges of adhering to FHIR standards, public reporting mandates, and various data exchange security concerns, say payers.
Mounting interoperability challenges constitute a significant concern for payers and providers alike. CMS, perhaps aware of the lack of clarity around new API requirements, does not appear to be enforcing the rule for payers. This will continue to harm the overarching goal of interoperability in healthcare, affecting patients, providers, and the payers themselves in several ways:
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● Providers rely on data from various sources, organizations, and applications. Walling off data from them hinders clinicians from providing timely, data-driven care.
● For optimal patient care provision, clinicians require longitudinal patient history. When a patient switches providers, their clinical history often does not follow. If payer databases lock that information in, the complete EMR—and patient history—can be lost, creating a piecemeal view instead of a comprehensive one.
● Independent providers struggle to attain patient history, particularly if they are not part of a large health network. Small providers suffer if data access is restricted.
● With stringent data protection, both providers and payers can miss strategic opportunities for appropriate individualized engagement and allocation of care management resources at the point of new member/patient engagement—as well as other operational efficiency opportunities and competitive advantages.
Facilitating consumer-driven data exchange through APIs is proving to be a journey, not a destination. For patients, healthcare data is either difficult to find, difficult to access, or difficult to understand. On the payer and provider end, disparate sources make both data ingestion and dispersion significant concerns.
As an industry, we cannot sacrifice the protection of data for the achievement of interoperability. We must be working toward an environment where data flows simply and securely, affording patients the ability to personally engage and make fundamental decisions about their healthcare.
About the author: Jonathan Shannon is the senior director of healthcare strategy at LexisNexis Risk Solutions.Back to HCB News
