Interoperability is Coming: Harness Its Potential

Before the arrival of electronic medical records (EMRs), there was no interoperability: exchanging data meant picking up a phone or sending a fax. EMRs promised a more seamless way to transfer information between care settings. But nearly a decade after the first set of meaningful use deadlines came and went, interoperability remains an unsolved promise. 

“EMRs have not really done what we hoped,” explained Dr. Don Rucker, national coordinator for health information technology, in his keynote address to XCHANGE 2019 Summit attendees. “I went into this business hoping to automate things so I didn’t have to work. We are the only industry in the world that has managed to use computers to make more work for ourselves.”

That’s where a little-known section of the 21st Century Cures Act comes in. Signed into law in 2016, the act deals largely with medical product development, but it also has key sections related to interoperability. Namely, the act defines interoperability, sets form requirements around API design (which help jumpstart the development of new tools and applications), puts an end to information blocking and requires health information exchanges to use a common framework.

Joan Butters, XSOLIS CEO, speaks with Dr. Don Rucker

Dr. Rucker’s agency is charged with creating the rules that relate to these provisions in the law, and he used his keynote to update XCHANGE attendees on where things stand and where things are headed.

The problem with APIs – which are used to create applications and exchange data – in the past had been the variety of technologies that were used to build them. Over the years, Fast Healthcare Interoperability Resources (FHIR) has emerged as the protocol of choice for interoperability. Dr. Rucker said more and more APIs are built using that language, and a proposed rule from his department, the Office of the National Coordinator (ONC) for Health Information Technology, would require the use of FHIR standards in API development. He explained that the Centers for Medicare and Medicaid Services (CMS) is also interested in interoperability and pointed to companion rules that would require payers to enable claims data access via APIs.

The proposed rule, which could be final as early as December 2021, also implements the information blocking provisions of the Cures Act, including identifying seven allowable exceptions to information blocking, such as engaging in practices to prevent patient harm. 

As the ONC works through public comments on the proposed rule—they received more than 2,000, he said—work has begun on the health information exchange front as well. In September, the ONC awarded a contract to the Sequoia Group for developing, updating, implementing and maintaining the common agreement.

So, what are the benefits of interoperability, particularly for an audience like the one at the XCHANGE? “Better access to data,” Dr. Rucker said. “The earlier you can get it, the more creative you can be on your interventions.”

Three Key Takeaways – While it’s been a long time coming, interoperability remains a hot topic in healthcare. Here’s what you need to know now.

  1. It’s a government priority. Following enactment of the 21st Century Cares Act, the ONC and CMS got to work on a variety of initiatives related to interoperability.
  2. Change is coming. The ONC released proposed rules related to API design and information blocking in February 2019. With a final rule expected by the end of 2019, these changes could go into effect as early as December 2021.
  3. New opportunities await. With greater interoperability, case managers would have access to greater pools of live clinical and financial data, equipping them to make faster, more informed decisions.

This blog is part of an ongoing recap of our user summit, XCHANGE 2019.