October 6th, 2022 was a momentous day. A milestone for ONC Information blocking rules was reached. The definition of Electronic Health Information is no longer limited to the US Core Data for Interoperability version 1 (USCDI v1). Is this signaling a coming FHIR Storm for EMR systems?
The US healthcare landscape has changed dramatically in a few short years. The pandemic accelerated the general acceptance of Telehealth. The pandemic also highlighted the importance of data for population health.
While the Pandemic drove the adoption of new ways to interact, the regulatory landscape was also changing. The CMS Interoperability and Patient Access Rule pushed organizations involved in Medicare and Medicaid programs to adopt the HL7 FHIR specification to enable member access to their health plan information. Hundreds of Health Plans have developed the ability to handle data in the modern FHIR standard.
CMS did not act alone. The Interoperability Rule was informed by work conducted at the Office of the National Coordinator (ONC) that has been promoting the use of the FHIR specification amongst the technology vendors supporting providers.
As we look towards 2023 we are primed for a FHIR storm of change. What is coming:
- By January 1, 2023 any product on the ONC’s Certified Product List will need to comply with the new (g)(10) certification.
- The (g)(10) certification requires the support of the HL7 FHIR US Core 3.1.1. specification. This mandates support for a comprehensive FHIR record set that represent the FHIR implementation of USCDI v1.
- US Core 3.1.1 not only defines the record formats. It also defines the methods of access, including supported search methods.
- ONC rules also put control of the US Core FHIR APIs under the control of the Provider organization instead of the EMR vendor.
- In December 2020, CMS issued a proposed rule relating to Burden Reduction. The rule was withdrawn and the industry has been waiting for a revised version to be released. That rule is now with the OMB for review. We expect the revised proposed rule to be released within 3 months. This has the potential to dramatically reshape the administrative landscape for health plans through the definition of standards for Prior Authorizations. The Burden Reduction regulation may also tighten up the requirements around Payer to Payer exchange that was included in the Interoperability Rule and require the use of FHIR for the exchange.
- The No Surprises Act is also leading to regulatory action that will require Payers and Providers to work together to share Good Faith Estimates and Advanced Explanation of Benefits before elective clinical procedures to ensure a patient doesn’t receive an unexpected (surprise) bill. This will tie in with industry efforts to define FHIR-based processes for exchanging this information.
How Do These Changes Interact?
When Providers are in control of the FHIR APIs that their Certified EMR make available they can enter into Value-Based Care arrangements with Payers that can be based on real-time clinical data. Payers will be able to negotiate access with their Provider networks.
The requirement that the US Core 3.1.1 specification must be supported to achieve (g)(10) certification for EMRs also creates a baseline in terms of the data that can be accessed and they types of searches that can be accomplished. This standardization enables solutions to scale with easier, more standardized implementation.
Payers and Providers can now work together to implement integrations without requiring the blessing or permission of the EMR vendor. FHIR technology implemented as part of the CMS Interoperability Rule can be easily adapted to enable Payers and Providers to rapidly integrate and share data for a Health Plan’s members.
If you want to learn more about solutions to tap the FHIR APIs available from provider EMRs contact us.