Overview
The RISE West 2021 session on data interoperability, titled “The New World of Data Interoperability: Linking Administrative and Clinical Data,” focused on the evolving landscape of healthcare data sharing. The session highlighted the challenges and opportunities presented by government mandates, such as the requirement for healthcare organizations to adopt interoperability standards by 2025. With insights from experts like Richard Lieberman, Chief Data Scientist at Mile High Healthcare Consulting, and Michael Klotz, Managing Consultant at MK Advisory Services, the session explored the implications of these changes for health plans, providers, and patients.
Key Takeaways
One of the central themes of the session was the impact of the 21st Century Cures Act, particularly Title IV, which aims to advance interoperability and prohibit information blocking. The final rulemaking from this legislation requires most CMS-regulated payers to implement secure, standards-based APIs (Application Programming Interfaces) using the HL7 FHIR (Fast Healthcare Interoperability Resources) standard. This mandates the seamless exchange of patient information, allowing for the creation of a comprehensive, longitudinal medical record that follows patients across different health plans.
Implications for the Healthcare Industry
The session underscored the transformative potential of interoperability in enhancing risk adjustment, quality measurement, and care management. By unlocking access to clinical data from electronic medical records (EMRs), health plans can improve the accuracy of risk scores and develop more effective care strategies. However, this also brings new challenges, including the need for healthcare organizations to adapt to complex data standards and ensure compliance with stringent regulations. As the industry moves towards full interoperability, the insights shared during RISE West 2021 will be crucial in navigating this new era of healthcare data exchange.