As the healthcare industry awaits the final version of interoperability rules proposed by CMS and the Office of the National Coordinator for Health Information Technology (ONC) that would transform the way the healthcare industry shares data, HRI talks with PwC Managing Director Lisa Gallagher about the implications for payers and providers (read HRI’s report examining the potential impacts of the rules here). Gallagher also was co-chair of the Health IT Standards Committee of ONC, as well as vice president of HIMSS.
The proposed rules would require healthcare companies to make patient data available through APIs so consumers can access their data via apps. What new processes or workflows might these rules require of healthcare companies?
Many people interpret compliance with these regulations as a technical implementation. Not only is this a technical exercise, but there are significant administrative and workflow processes that need to be implemented or modified.
HRI: Do you foresee that these rules would require sizable investments from healthcare companies?
Lisa Gallagher: For providers, things like creating a system to notify other providers, changing discharge procedures, intaking patient requests and connecting APIs are all going to have significant administrative, process and cost implications and any newly created regulatory compliance programs will also have to get included in that cost.
For the payers, they have to look at the cost for reviewing their processes and procedures and their own ability to pass along full claims history and encounter data about the right patient and connect to the national [health information exchange].
The overall cost impact and structure is important to look at too, because downstream, how is it going to affect plan premiums and other things that directly affect the patients? So as the regulations are released, an assessment of the current state, putting in place a road map and managing the cost of a response to these requirements in a very short time is something that can be a challenge as well.