Loading...

In today’s rapidly evolving healthcare environment, the demand for a comprehensive, seamless exchange of health data has never been more urgent. Key to achieving the Quadruple Aim of Healthcare—enhancing patient experience, improving population health, reducing costs, and easing provider burden—is robust interoperability. The ONC Cures Act Final Rule of 2020 and CMS’s Interoperability Rules (CMS-9115-F and 0057-F) represent pivotal regulatory efforts toward building a truly connected healthcare ecosystem.

The journey began with the Meaningful Use program in 2011, which led to widespread adoption of Electronic Health Records (EHRs). Yet, despite that success, seamless data sharing across stakeholders—providers, payers, and patients—remains a challenge. The lack of a unified, nationwide network limits access to longitudinal patient records, hindering care continuity.

Early attempts like the Nationwide Health Information Network (NHIN), Google Health, and Microsoft HealthVault faced setbacks, often due to placing the burden on patients or lack of standardization.

In 2020, the Office of the National Coordinator for Health IT (ONC)—now part of the Assistant Secretary for Technology Office (ASTP)—released the Cures Act Final Rule. This rule redefined how health data should be shared and laid the groundwork for an interoperable future.

• Trusted Exchange Framework and Common Agreement™ (TEFCA): This governance framework is designed to enable secure and standardized information exchange across different health entities.
• Qualified Health Information Networks (QHINs): Under TEFCA, QHINs form the infrastructure of the national network. These networks include Health Information Exchanges (HIEs), hospitals, clinics, and community health centers. Seven QHINs have already been accredited, with more expected.
• Information Blocking Rules: The rule also defines what constitutes information blocking and outlines exceptions where withholding data is permissible. This promotes transparency and trust in data handling.
• Health IT Certification: Vendors must follow clear testing procedures and conformance guidelines to ensure their products meet interoperability standards.

In parallel, Centers for Medicare & Medicaid Services (CMS) introduced two complementary rules—CMS-9115-F (Patient Access Rule) and CMS-0057-F (Interoperability and Prior Authorization Rule)—focused on enhancing data sharing among payers, providers, and patients.

• FHIR-based APIs: Payers must use HL7 FHIR APIs for secure and real-time data exchange.
• 360-Degree Patient View: Patients must have easy access to their complete encounter history and claims data.
• Data Sharing for Care Coordination: Payers are required to share data with care providers to streamline coordination and avoid redundant procedures.
• Data Sharing for coverage continuity: Payers are required to share data with other payers as patients move from one health plan to another. The information shared includes encounter, claims and other pertinent administrative and clinical information.
• Prior Authorization Transparency: APIs must provide detailed insights into the prior authorization process, including service coverage, status, and reasons for denial.

Together, these mandates not only reduce provider workload but improves payment and coverage transparency. They also empower patients with better access and control over their health information.

Built upon the TEFCA framework, SOVRINHEALTH 360™ is a Health IT Care Coordination platform that exemplifies the principles of interoperability and patient-centric design. It supports a wide range of use cases, from provider-patient access to care coordination across institutions, using industry standards like FHIR and USCDI.

• Aggregates data from multiple sources to create a comprehensive patient profile
• Automates care coordination workflows thereby reducing labor hours and increasing efficiency
• Reduces administrative costs and improves care outcomes
• Enhances transparency and streamlines communication between all stakeholders

SOVRINHEALTH 360™ represents a future where health data flows as easily and securely as online banking or e-commerce transactions.

With the combined leadership of ASTP/ONC and CMS, the U.S. is closer than ever to establishing a nationwide health information network. By addressing historical barriers to interoperability and promoting certified, standards-based data exchange, these regulations are reshaping how healthcare is delivered and experienced.

Whether you’re a provider, payer, or patient, the future promises better care, lower costs, and less friction—all powered by smart interoperability.