Healthcare Policy News

Bringing Payers, Patients into the Health Data Exchange Conversation

For interoperability and health data exchange efforts to be deemed successful, they must allow providers, payers, and patients to interact in meaningful ways based on accurate and timely information

Interoperability, health data exchange

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By Kyle Murphy, PhD

- The adoption of electronic health records and creation of health information networks have spurred greater health data exchange between providers. While plenty of work must be done to ensure providers can share patient data to better inform clinical decision-making, even more effort is required to bring payers and patients into the national conversation about access to health data and the ability to move health information to help the industry improve care, outcomes, and costs. 

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“One of the issues that we struggle with is just making sure we have the right people at the table,” said Carequality Executive Director Alan Swenson in the most recent episode of Healthcare Strategies.

Carequality is an interoperability framework that supports nationwide care coordination by providing legal agreements to ensure trust, technical specifications to enable information exchange, and participant directories to facilitate information sharing. 

“We started with a focus on provider organizations exchanging treatment purposes, and we’ve done a lot of great work there because we’ve got a lot of providers, their EHRs, and HIEs at the table helping to create those policies,” Swenson continued. “When we start talking about policies around how to improve patient access, payer access, public health access, etc. — anything really outside of treatment — it gets difficult when you’ve got a bunch of provider organizations at the table talking about how they should be responding to payers without the payers at the table, explaining what they need and the policies that would benefit them.” 

Enabling both payers and patients to participate in health data exchange became a focal point of federal policy and regulation published by the Centers for Medicare & Medicaid Services prior to the onset of the coronavirus epidemic. While certain provisions of interoperability rules have been delayed — for example, payer-to-payer exchange — others pertaining to making protected health information and claims data available to patients have gone into effect. The use of application programming interfaces — that is, Fast Healthcare Interoperability Resources (FHIR) — will ensure that information is able to move securely and efficiently between stakeholders. 

To ensure alignment of providers’ and payers’ efforts, it is essential for organizations such as Carequality to help coordinate these actions. 

“We have everyone at the table to understand what’s needed on the payer side or on the patient side or on the life insurance side — whoever else it is that needs information — and then come up with the policies that also satisfy the concerns of the provider so that we can get all of this automated and allow the infrastructure that exists and is being used for treatment-based exchange to also cover all of those other forms of exchange and get rid of the need for one-off agreements, millions of fax pages, and everything else and just let the system handle the requests appropriately,” Swenson noted. 

To advance interoperability and health data exchange further, Swenson envisions that the technical and legal components of information sharing will move to the background. This will allow healthcare professionals from providers and payers and patients to give their whole focus to making the best use of shared data possible without concern for the behind-the-scene systems facilitating the movement of information. 

“Information should be where it’s needed at the time it’s needed,” Swenson explains. “When providers just have the information that they need, patients can just access their own information without having to remember ten different portal logins, that is achieving interoperability. We can stop talking about what interoperability means. We’re not there yet, and we’ve still got a ways to go, but we’ve made a ton of progress in past years, lots of exciting stuff in the coming years. We’re definitely getting closer.” 

As the healthcare system achieves new levels of interoperability, the goalposts shift to prompt more advancement. For any of this effort to matter, it must lead to providers, payers, and patients being able to engage in healthcare conversations based on accurate and timely information.

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