Interoperability Compliance: A Marathon of Sprints

By: Charlie Provenzano

Healthcare interoperability is intimidating. Though the July 1, 2021 compliance deadline has come and gone, a lot of payers continue to struggle with the many moving parts: which interoperability requirements are applicable for your organization; what data must be shared with patients, other payers and third parties; and how best to convert that data to the Health Level 7® (HL7) Fast Healthcare Interoperability Resources® (FHIR) standard. The cross-functional nature of interoperability adds to its complexity. Should it fall to compliance? IT? Member experience? Going into 2021, more than half (56%) of more than half (56%) of payers and providers had yet to designate a leader to advance their interoperability initiatives.

The end isn’t in sight

If you’ve already met the deadline for Patient Access and Provider Directory APIs, you’re doing well. Perhaps you’re already working on a Payer to Payer initiative for compliance on January 1, 2022. (And if you’re behind the game, keep reading – we’ll have some FHIR-specific answers for you.) You’ve been immersed in FHIR for some time now, and it feels like the end is in sight.

At HealthLX, we don’t think it is. Requirements for compliance are going to continue to evolve, at least over the next three to five years. V2 of the United States Core Data for Interoperability (USCDI) is already coming soon. Ongoing changes to the FHIR Implementation Guides can create the need for code updates for conformance. In addition, payers and providers will need to do ongoing work as their business relationships change.

Moving forward with FHIR

FHIR doesn’t have to be a four-letter word for your organization. As FHIR adoption becomes more widespread across the industry, it’s going to be transformative – we believe it will be changing for the better. You can position smarter for a FHIR-enabled future by:

  • Ensuring you have a solid foundation right now, so your organization can build with fewer missteps and less expense in the future

  • Shifting your mindset. Just 24% of payers and providers view the new interoperability rules as an opportunity.

Opportunities are in fact starting to emerge. Amazon HealthLake is one example. Amazon HealthLake is a HIPAA-eligible service offering healthcare and life sciences companies a complete view of individual or patient population health data for query and analytics at scale. How would your organization manage business and deliver patient experiences and outcomes differently if you had access to leading-edge AI-enabled analytics? Amazon HealthLake aims to reduce the time and cost barriers to building those models, so more payers can access these analytics. To get started, you need FHIR resources. As an AWS Connector Partner, HealthLX will enable companies to use Amazon HealthLake storage and analytics capabilities by helping them securely transform their healthcare data into FHIR resources.


Circling back to the now

If your organization is struggling with FHIR and compliance with federal interoperability rules, get in touch with HealthLX. Our CMS Interoperability Rescue Plan for Payers is designed specifically to move you forward to a clear plan that shows CMS how your organization will meet each requirement. From there, your team can take it to the current finish line, or we’ll partner with you to make it happen. Our specialized team can get your rescue underway.

Let’s Get Started

We Want to Know What Data Integration Needs You Have!