Karen Kobelski is the vice president and general manager of clinical surveillance, compliance & data solutions at Wolters Kluwer. She brings more than 25 years of experience to her position, which expands her previous leadership role over the Safety & Surveillance group to also include the Health Language portfolio of data normalization solutions.
The interoperability rules recently finalized by the Office of the National Coordinator for Health Information Technology (ONC) and CMS aim to achieve seamless exchange of medical information among health care stakeholders to improve health outcomes and reduce unnecessary costs. For information to flow freely across the health care system, it is critical that all players—providers, payers, and health IT vendors—adhere to the same rules and standards. It is also essential to ensure data can be provided to patients by third parties in a timely manner and in an easy-to-understand format.
For health plans, compliance with these rules will be no small feat, requiring entirely new strategies for data management and significant IT investment. The rules require plans to provide patients access to their data via the FHIR Release 4 standard beginning January 1, 2021, as well as the ability to facilitate data exchange with providers or other payers using the data classes defined within the United States Core Data for Interoperability (USCDI).
Health plans have limited experience with these standards compared to providers, and after years of investing in point solutions, acquiring smaller plans, or expanding their services to support new member cohorts, most plans are managing multiple claims processing systems, analytics platforms, data warehouses and member portals that have created dozens if not hundreds of data silos.
Getting the Data House in Order
To get on the right path, and ensure regulatory compliance by 2021, plans must address data silos and embrace the following “truths” for efficient data-sharing in the new environment:
With enforcement around the corner, plans need to act now to address the data silos that will impede their progress, as well as transform how they collect, manage and share data going forward – all while ensuring member consent, privacy and comprehension. It is a lot to tackle in a relatively short period of time, but with the right preparation and partnerships, plans can get there.
Looking ahead, as data becomes increasingly transparent and exchanged via a trusted network, it will be crucial that payers are equally diligent in ensuring data is accurate, clean, and actionable for long-term success. The steps that CMS and the ONC have taken to press forward on interoperability represent only the tip of the iceberg.