On May 1, 2020, the Centers for Medicare and Medicaid Services (CMS) released the Interoperability and Patient Access final rule, with the goal of giving patients better access to their health information. Great progress has been made since the rule was enacted. Today more than two-thirds of payers have made Patient Access APIs available.
However, health plans still face challenges and barriers with FHIR adoption and must address those obstacles to keep progressing and ensure high priority interoperability needs are met.
To gain a better understanding of implementation approaches and lessons learned from the health plans’ experiences, CAQH conducted an informal survey of stakeholders involved in interoperability efforts and found three common themes:
Over 50 percent of respondents indicated that managing competing priorities persists as the biggest barrier to FHIR implementation. Healthcare organizations are still grappling with the impacts of the COVID-19 pandemic, staffing shortages, and required compliance to other intense regulations like the No Surprises Act. Organizational interoperability will require structural changes to support secure data exchanging and shouldn’t be underestimated as a small undertaking for health plans.
Low member engagement rates don’t add additional urgency for health plans either. When asked, all plans estimated that between 0 and 5 percent of members have utilized Patient Access APIs. While the goal of the CMS Final Rule is to provide patients better access to their health information, if engagement levels remain low payers won’t see a sense of urgency to improve and enhance these APIs. Also, many app vendors are waiting for payer APIs to mature before investing heavily in integration, and payers have not been working out API issues because low usage has not yet exposed many technical issues. Standardized testing tools, such as Aegis Touchstone and certification processes, such as Drummond FHIR API Certification can help address these gaps.
Security was listed as the top concern regarding compliance with FHIR standards. Payers indicated that there is still a concern that patient data could be exposed to unauthorized parties when using FHIR APIs. Health Level Seven (HL7) International, has taken steps to respond and counter those security concerns, however, it’s evident that payers are still hesitant. Common resources and greater guidance on security would help address this gap.
Though there has been some positive progress towards greater data interoperability over the last two years, there’s still work to be done. Health plan and app vendor commitment to address these challenges and improve the consumer experience would enable the Final Rule to improve interoperability and usher in the next generation of healthcare.
Learn more about how CAQH is working with app vendors and health plans to support interoperability.