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What payers and providers need to know about the ONC and CMS information blocking rules

April 12, 2021
Business Affairs Insurance
Scott Galbari
By Scott Galbari

Provisions of the ONC and CMS interoperability rules begin to take effect in April of this year, and payers, providers, HIEs, and the developers who deliver HCIT solutions to these organizations are feverishly working to comply despite the many challenges they’ve faced as a result of the pandemic. The pandemic has diverted resources and focus away from many strategic initiatives – and interoperability is no exception.

However, responding to the pandemic and meeting regulatory compliance are not mutually exclusive. Strategic health IT organizations are realizing that they can simultaneously make progress toward rule compliance while managing the demands of the pandemic. Specifically, by leveraging advanced integration technology, healthcare organizations can ensure compliance, and improve efficiency and efficacy of pandemic-driven IT initiatives.

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Here’s what organizations should know about the rules
The new rules serve two main purposes. One is to eliminate information blocking by organizations and software platforms and optimize data sharing across disparate systems. The second is to liberate patient data by increasing the use of FHIR APIs to improve consumer access to information and tools that help them make informed and empowered healthcare decisions.
Though these requirements represent a significant challenge to the status quo of data exchange, they can be met in ways that optimize automation, efficiency, accuracy and security by using appropriate interoperability tools. These tools can also play a critical role in meeting the demands of the pandemic, including sharing data at-scale from heterogeneous sources such as testing centers and labs, contact-tracing systems, and vaccination management systems.

So what does this mean for payers and providers?
Payers and providers struggle with data integration for different reasons. Though provider organizations are likely to have the technology to store and aggregate patient data, they are often not equipped to effectively share it safely and securely among disparate systems and entities without compromising it in some way.

For payers, their interoperability challenges are the result of antiquated manual and paper-based processes and workflows as well as decades of merger and acquisition activity, which has left inefficient processes in its wake. Due to reliance on significant manual human and paper driven workflows, payers are left to deal with chronically “dirty” claims data and a host of related issues.

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