The CMS new Interoperability and Patient Access Proposed Rule focuses on ensuring seamless exchange of health information between stakeholders and giving members access to their medical records in digital format. The proposed rule aims to drive better care coordination, improve patient outcomes and foster innovation through greater access to data for researchers, using the FHIR standard. With this new rule likely to be implemented in the next few months, health plans need to upgrade their existing data management and reporting mechanisms to be compliant. However, payers will need to address a number of key challenges to achieve this.
To begin with, health information within most payer organizations is still maintained in siloed systems. Payers and providers do not have access to a ‘single view’ of member or patient health information, making it difficult to share data effectively, coordinate overall care quality and improve service delivery. Payers also need to address complex data sharing challenges that span across various ecosystem participants, such as members switching insurers, providers sharing member data with payers, or members having access to support data (e.g. networks) from payers.
Vice President, Data Management Proficiency
Swanand leads the CitiusTech Healthcare Interoperability / BI-DW / Big Data practices. With more than 18 years of experience in information technology Swanand has worked across regulatory reporting requirements such as MU, and healthcare standards and frameworks including HL7. Swanand has also served as the Senior Architect for the development of CitiusTech’s BI-Clinical product. Prior to CitiusTech, Swanand was with Epic Systems where he worked on development of EpicCare product. Swanand holds a Master’s degree in Information Technology from IIT Mumbai.
Guninder is a healthcare consultant at CitiusTech with 10 years of domain experience in the Healthcare IT industry having worked with payer and provider clients. A certified product owner having developed innovative solutions, she has worked on projects including business & market analysis, healthcare industry trend analysis and consulting.