How Application Programming Interfaces Apply to Healthcare Entities
ONC Final Rule
On May 1, 2020, the Federal Department of Health and Human Services (“HHS”), Office of the National Health Information Technology Coordinator (“ONC”) released a final rule (the “ONC Final Rule ”), which implements the information blocking provision of 21st Century Cures Act, signed into law in 2016. Information blocking provision applies to health care providers, health informatics (“HIT”) developers and health information exchanges/networks (“HIE”) ).
“Information blocking,” in this context, refers to actions that discourage or interfere with the interoperability of electronic health information (“EHI”), except where necessary to comply with laws, such as HIPAA. An example of a common instance of information blocking is when healthcare entities charge patients unreasonable fees for copies of their electronic medical record. Ultimately, information blocking hampers the desired full interoperability and exchange of EHI.
In order to improve interoperability and prevent information blocking, the ONC Final Rule requires that certain technical certification criteria be implemented. The ONC’s final rule affects various types of healthcare entities, but HIT developers are the most affected. Although many HIT developers understand the generalities of the ONC Final Rule, many HIT developers now struggle to understand the requirement that HIT developers must ensure that their HIT is in a format a secure and standardized application programming interface for patient and population services (“API”). , so that providers can support a patient’s access to basic data in their electronic health record. The ONC’s final rule also includes provisions that make it easier for patients to obtain their EHI in a safer and easier way at no additional cost when they access it electronically through the app of their choice.
To understand why APIs are important, it helps to understand what an API is. APIs allow different applications to interact with each other without the need for each application to know how the other application’s software is designed internally. APIs require the use of HLZ Fast Healthcare Interoperability Resources (“FHIR”), which is the industry standard for information exchange. FHIR essentially works as a translator between different apps, so each app can share data with each other in a language each app can understand.
To ensure that interoperability is the norm going forward, ONC’s final rule included a requirement that all HITs certified through ONC’s certification program must have standardized APIs for patient and community services. By implementing this requirement, the ONC seeks to minimize the “special effort” required for healthcare providers, patients, and their authorized representatives to access, exchange, and use electronic health information through certified APIs.
CMS Final Rules
In conjunction with the ONC Final Rule, CMS published the Final Interoperability and Patient Access Rule on May 1, 2020 (the “CMS Final Rule”). HIT developers follow the ONC’s final rule, because the ONC certifies HITs. However, the CMS final rule is not for HIT developers, but rather for payers and some vendors as well. The CMS Final Rule finalized three new policies that allow patients to access their health information: 1) Patient Access API; 2) Supplier Directory API; and 3) exchange of data between payers.
For the Patient Access API, some CMS-regulated payers are required to implement and maintain an FHIR API that allows patients to easily access their requests and encounter information, including cost, as well as a defined subset of their clinical information via third parties. candidacies of the party of their choice. For the Provider Directory API, the CMS Final Rule requires certain CMS-regulated payers to make provider directory information publicly available through an FHIR API, making it much easier for patients to find information about providers and clinicians.
Finally, for payer-to-payer data exchange, some CMS-regulated payers are now required to exchange certain patient clinical data upon patient request, allowing the patient to take their information with them when he switches between payers overtime to help create a cumulative health record with his current payer. Having a patient’s health information in one place will facilitate informed decision-making, effective care, and ultimately can lead to better health outcomes.
The ONC Final Rule and the CMS Final Rule work together to implement the 21st Healing Act of the Century. The final two rules discourage information blocking and encourage interoperability. Payers, HIT Developers, HIEs, and Healthcare Providers should work to implement the applicable requirements, as the CMS Final Rule is now in effect, and many provisions of the ONC Final Rule will be applied between the middle and the end of 2022.
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This article originally appeared in Healthcare Michigan, March 2022.