Name one issue on which both Republicans and Democrats agree. No, seriously.
I only know of one right now: the ability for consumers to access their own healthcare information and use it to make decisions.
For the last year, I’ve been traveling the country evangelizing on healthcare data interoperability, explaining the proposed federal interoperability requirements to health insurance companies and hospital systems and why and how this rule is good for healthcare. In a nutshell, the proposed rules from the Centers for Medicare & Medicaid (CMS) introduce new policies that will expand access to health information and improve the seamless exchange of data in healthcare.
Some major electronic medical records (EMR) vendors believe the industry should oppose the healthcare data interoperability rule because of privacy, data and information security concerns; however, this insinuates that allowing entities other than EMR vendors to create patient apps would put patient data security at grave risk.
Because CMS and other major healthcare players are pushing right back, we expect interoperability to move forward. That said, these new regulations will require technology and processes very different from those healthcare institutions use today. While this change isn’t easy, I’ve been delighted to see how many of the leaders among our clients are looking beyond their initial compliance effort to imagine how these new requirements, once implemented, will fundamentally change healthcare – not unlike the way ATMs changed banking and Uber changed taxis.
A New Approach to Healthcare Data Ownership
To comply with the proposed interoperability rules, most health insurers (payers) will have to provide a common application programming interface (API), a standardized “docking collar.” These APIs will turn a process that today is very difficult – getting data out of silos – into one that will make it incredibly easy for software to access and transmit information. Coupled with very strong protections for privacy and security, much like those that banks have used for 20 years, these APIs can deeply disrupt how healthcare operates.
Consumers will be able to go to the app store and download one of the hundreds of new apps that will appear, enabling them to get their data from whatever insurance company they have. Anyone can write these apps, not just EMR vendors and payers. These apps will help consumers shop for cheaper medicines, make decisions about their care, allow them to carry their medical history with them and show it to anyone they wish, and accomplish whatever else the fertile minds of smart people can conceive. When coupled with recently available analytics, such as evolutionary AI, the apps will help consumers better understand their own health and empower them to ask the right questions and get the right care.
Care Management Driven by Data
Similarly, from our vantage point as a leader in delivering care management services, we’re excited about how interoperability will create new opportunities for improving care. First, under the new interoperability rules, when members switch plans, they may ask their old plan to transmit all the data it has collected about them to their new plan. Forget the technology involved there for a minute and consider the care management implications. Today, it takes plans a year to capture and analyze enough member data to determine which members would benefit from care management. And by the time plans have that data, members often have changed plans again, starting the data collection cycle anew.
Under the healthcare data interoperability rules, health plans could receive historical member data at virtually the same time the member’s coverage is activated. Plans could then determine, within hours, which members need extra attention and assign the appropriate care managers, primary care physicians, medical homes, etc. That’s an entirely new level of service that results in lower medical costs and greater health benefits to members.
Opening the Tent to More Data Sharing
Finally, I think the Department of Health and Human Services (HHS) will soon extend the same interoperability requirements they are placing on payers to hospital systems and doctors. When data can flow directly from EMRs to payer systems, utilization management becomes truly touchless and automated. Instead of time and money spent on personnel managing phone calls, emails and faxes, health plans can use inexpensive computing cycles to gather medical data, process it and transmit authorization decisions.
By combining all the data that is siloed today, healthcare organizations would be able to use science to identify patients who need care much earlier and deliver that care faster, cheaper and with better quality, making healthcare work the way so much of the technology in the rest of our lives works.
The healthcare data interoperability rule would make all these developments possible. The bottom line: My health data should be mine to do with as I wish. If EMR vendors will indeed be forced to allow me to assemble my own data from multiple systems, I can partner with payers and providers of my own choosing to make better healthcare decisions for myself. Why wouldn’t Democrats and Republicans agree about that?
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