Interoperability Solutions

Using IT systems and software applications to communicate and exchange data in order to advance effective healthcare delivery.

Getting Started and Finding A Healthcare Interoperability Solution

Healthcare interoperability has been an industry buzzword for some time, but upcoming compliance deadlines for the Office of the National Coordinator for Health Information Technology (ONC)’s Cures Act Final Rule—which implements interoperability requirements detailed in the 21st Century Cures Act—have created an imminent need for health plans to find a healthcare interoperability solution.

ONC Cures Act Final Rules

The rule outlines healthcare data interoperability standards designed to promote data exchange and transparency across the healthcare ecosystem, with a goal of empowering patients related to their own healthcare.

Principles

  • Improved Data: Standard APIs are supported by FHIR®—an electronic data exchange standard adopted by CMS and the ONC for clinical data shared across platforms, organizations, and clinicians.
  • Convenient Access: Patient access to healthcare information enables patients’ control of their own healthcare decisions.
  • Transparent Information: Expand patient and payer choices by delivering data to assist in care decisions related to quality and costs.

Benefits

  • Patients: Education from secure, instant access to health information via apps allows increased ownership of care decisions.
  • Health Plans & Partners: Readily available, holistic patient and population data enables more prevention programs and patient education.
  • Hospitals & Health Systems: Real-time availability of historical medical records enables timely and improved patient outcomes.

Compliance Requirements Impacting Health Plans

1

Payer-to-Payer Data Exchange

Effective 1/1/2022

As patients change health care plans and request sharing of their health information between plans, payers must be able to exchange all data within the standardized data requirements. Plans are responsible for a bi-directional data flow: (1) receiving and ingesting member data from another payer, and (2) sending former member data to other payers. All payer data must be accessible and available for exchange for five years.

2

Patient Access API

Effective 7/1/2021

Patients must have direct access via third-party applications to their healthcare information as of January 1, 2016. Healthcare information data sharing requirements are specified and include four categories: claims information, encounter data, clinical information, and formulary data. Plans must provide this data in the required, standardized specifications via API, providing API documentation and appropriate security and maintenance checks.

3

Provider Directory API

Effective 7/1/2021

Plans must make in-network provider directory information (e.g., provider names, network statuses, specialties, addresses, phone numbers) available via FHIR® API. Within 30 days of receipt of new data, that information is required to be available via the Provider Directory API.

Healthcare Interoperability Solutions

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CAVO® Connect

CAVO® Connect enables health plans and review vendors—within configurable release rules—the ability to access medical records, itemized bills, and additional clinical data. Review teams then perform reviews without utilizing hospital and health system resources for release of information (ROI) requests.

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Why Choose Advent for Healthcare Interoperability Solutions

Technology Platform

  • Open API, no information blocking
  • HIPAA compliant and HITRUST certified framework

Clinical & Claims Expertise

  • Assist with data normalization and mapping between siloed systems, minimizing payer time investment

FHIR® Expertise

  • Development team with experience building APIs supported by FHIR® 4

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