Navigating the future of healthcare: Key insights on CMS's proposed rules for interoperability

In a bid to propel the healthcare industry forward, the Centers for Medicare & Medicaid Services (CMS) introduced two groundbreaking rules in December 2022. These rules aim to establish common, open-industry standards, fostering interoperability, stimulating innovation and simplifying processes for providers and payers.

One pivotal aspect of the proposed rules involves payers creating application programming interfaces (APIs) to share patient information with healthcare providers, streamlining data flow for improved patient care. The industry has seen the adoption of various standards, including HL7 Fast Health Interoperability Resources (FHIR, pronounced “fire”) and Direct Standard messaging, posing both opportunities and challenges.
 

Healthcare, unlike other industries, involves complex interactions between patients, providers, and payers. Reaching agreements on services, costs, and payments requires extensive information exchange, often resulting in patient frustration and provider inefficiencies.

However, achieving interoperability comes with hurdles. Competing standards, unstandardized records and data meaning ambiguity are prevalent concerns. The stress on the system is escalating, compounded by rising treatment volumes.

Despite the challenges, technology offers solutions. Electronic transactions are not only faster and less error-prone but also significantly more cost-effective. The healthcare industry, recognizing the need for change, is actively engaged in addressing data interoperability through initiatives like the Trusted Exchange Framework and Common Agreement.

CGI Federal emerges as a key player in navigating this complex landscape, particularly in implementing the FHIR standard. With expertise spanning two decades, CGI Federal collaborates with federal government healthcare agencies, leveraging FHIR to remove friction, reduce manual steps and enhance overall healthcare agility. CGI Federal's experience and insights promise a roadmap to improved patient care, streamlined processes and a future where healthcare embraces innovation seamlessly.

For an in-depth exploration of CMS's proposed rules, interoperability challenges, and the transformative potential of FHIR, and a look at what stakeholders can expect in the coming years, we share some thoughts in this white paper.