Following numerous conversations among health care organization leaders, a vast spectrum of implementation approaches has emerged with respect to preparation for interoperability and the 21st Century Cures Act. Healthcare organizations are also in various stages of implementation, from those just getting started to those who are well underway in meeting the federal mandate. Perhaps the most interesting discussions center on what, at a minimum, is needed on January 1, 2021 when the Act goes into effect, and what can wait for later stages of the program.
With so much uncertainty in the healthcare delivery space, given the impact of COVID-19, the state of the U.S. economy and consumer confidence, and the undefined timeframe for resuming in-person delivered healthcare, many implementing the Cures Act are favoring minimum compliance. Specifically, healthcare payers will support public Application Programming Interfaces (APIs) to provide drug formulary information and provider directories. Additionally, they will provide an API for members to access up to five years of claim and encounter information, as well as the clinical data the organization manages.
Healthcare providers must also support patient access to their health data through third-party APIs. They will all support these APIs and share member-requested data at no cost to the consumer. No information blockers here! However, the consensus seems to favor that only a small volume of their consumers will embrace the new data availability initially and use this as their main argument for delaying a value-add solution, which is anything beyond minimum compliance. They may be right.
However, what if the providers are wrong, and their current and former consumers have been waiting for this opportunity to access their personal healthcare information? Imagine seeing five years of claim, encounter, and clinical data, filled with unfamiliar code sets and clinical shorthand.
The data will be presented in the correct format but left to the interpretation of the third-party application the member selected to access the data. This may be the case in some scenarios, but what if there were tools available and promoted by the healthcare organization, and powered by data analytics and Artificial Intelligence (AI) engines that could help a consumer find better answers to their medical questions than a search engine? Imagine a presentation layer that is as informative as it is intuitive, and encourages a consumer to examine their overall picture of health in a contextual format that presents both a clinical and financial view of healthcare possibilities.
At a minimum, the Cures Act promotes the sharing of healthcare data by establishing the patient as the data owner. A healthcare organization can offer a deeper perspective by presenting data in context, helping the consumer interpret their healthcare data, and establishing the beginning of a direct-to-consumer value-added solution. This is just one of many ways a healthcare organization can go beyond minimum compliance and embrace the true spirit of interoperability and the intent of the Cures Act.
For some healthcare organizations, the time may not be right to deploy a value-added Cures Act solution. What is important is that any solution deployed for the January 1, 2021 timeline allow for a future value-add solution without requiring rework. Borrowing a line from the movie, Field of Dreams, “If you build it, he (they) will come.” By making an investment in interoperability beyond minimum compliance, member engagement will increase, which can lead to better health outcomes and an improved consumer experience. This can differentiate your organization and establish it as a market leader.
The good news is that there is still time to develop an action plan to implement the required Cures Act changes. IQVIA offers a range of consulting services to assist healthcare organizations with assessing, planning, and implementing the changes required to comply with the Cures Act.
If you are not familiar with the Cures Act and interoperability, or would like more detail and an overview, download our white paper Cures Act: Getting Ready for the Implementation of TEFCA and Healthcare Interoperability Standards.