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Healthcare System Meets CMS Final Rule with API EHR Integration

A New Jersey health system integrated API technology into its EHR to meet the CMS new conditions of participation rule for Medicaid and Medicare.

Saint Peter’s Healthcare System integrated an application programming interface (API) into its EHR to adhere to the new Medicaid/Medicare conditions of participation rule and promote interoperability across its healthcare ecosystem.

Put into effect May 1, CMS’ conditions of Medicaid/Medicare participation rule requires hospitals to direct message the individual’s care team regarding patient events such as emergency room visits or admittance and discharge from the hospital.

“The idea is that the message is generated automatically by the EHR when one of these conditions are met,” Jordan Tannenbaum, vice president, CIO, and CMIO at Saint Peter's Healthcare System, told EHRIntelligence in an interview. “The result of this is better follow-up, less readmissions, and overall better care because it's supposed to follow up after a hospital encounter.”

In addition to the clinical quality improvements the rule seeks, these conditions of participation have some money tied to them. Healthcare organizations that fail to deliver on these requirements could get booted from Medicare and Medicaid altogether, which is a pretty big stick that can motivate adherence considering the broad population of Medicare and Medicaid beneficiaries.

However, leading up to May 1, not every organization was able to do this. Sending these kinds of notifications is a big interoperability task, and that level of seamless data exchange has been something of a white whale for the medical industry.

Care organizations can take several approaches to adhere to the new conditions of participation for Medicaid and Medicare.

However, hospitals must first ensure their EHR can send these kinds of direct messages. Most EHRs are capable of this kind of data exchange, Tannenbaum explained.

From there, care organizations can enable the EHR to send messages directly to patients’ care team, or they can send the information through a health information exchange, Tannenbaum added. Alternatively, organizations can adopt APIs to adhere to the final rule.

Saint Peter’s Healthcare System chose to integrate CarePort, powered by WellSky, a provider in care transition solutions. Tannenbaum said Saint Peter’s already had the API in place in its post-acute facilities, making the integration intuitive and seamless for the organization.

When a qualifying patient event occurs, such as a hospital admission or discharge, the API takes the HL7 message live out of the EHR and forwards it to the direct addresses for post-acute care providers listed on the patient’s record, Tannenbaum explained.

These providers may include skilled-nursing facilities, rehab facilities, primary care providers, or specialists.

“The API has the benefit of having a lot of information about those direct addresses for all the different post-acute care positions and providers,” Tannenbaum added. “They have a record of who has seen this patient outside that we don't know.”

This ensures that the correct people receive the direct message regarding a patient’s medical events, promoting care coordination through appropriate follow-up.

Tannenbaum noted that healthcare organizations can also add anybody else to the list of providers that receive automatic EHR direct messages through the API.

“If the patient says, ‘Listen, I want all my gastroenterologists or oncologists to know I was admitted here and please add them to the list,’ we could do that,” Tannenbaum said.

Tannenbaum explained that the receiver has the option to opt out of all or some direct messages.

“Maybe they don't want to know about ED visits, just admissions, or maybe they don't want to know about admissions, they just want to know when their patient is being discharged,” he said.

In terms of CMS enforcement, Tannenbaum explained that inspections by the Joint Commission and other agencies will now check on these conditions of participation.

Other CMS programs penalize care organizations for poor performance by diminishing payments and bonuses. However, Tannenbaum emphasized that a condition of participation is very different, as it stands as a minimum baseline to participate in Medicare or Medicaid.

While the rule only went into effect about five weeks ago, Tannenbaum noted some preliminary challenges.

To participate in direct messages, each hospital and physician’s office must have a direct email address. According to Tannenbaum, a lot of physicians still do not have a direct address.

Additionally, he noted significant workflow challenges with the receipt of direct messages. Instead of automatically matching up to the correct provider, direct messages often require manual sorting. Tannenbaum likened this to sorting mail in a mail room.

“Somebody usually at the practice has to actually attach that message to the patient record,” Tannenbaum noted. “Then there has to be a workflow where that message then gets in some kind of work queue for the physician.”

The direct message is supposed to indicate who the treating physician was and if possible, the diagnosis, so that the provider knows what kind of visit it was, Tannenbaum explained. This information allows providers to paint a better picture of the care encounter so they may conduct follow-up, if appropriate.

Although he hasn’t had time to see much impact yet, Tannenbaum said these new conditions will likely improve patient care, so long as notifications are workable across organizations.

He explained that hospitals will need to educate physicians and staff about the autogenerated messages so that they can develop workflows that ensure the data ends up in the hands of the provider for actionable use, not hidden in the backend of the EHR.

“I think that the payoff will be if we can get these messages in front of physicians or their delegates so they can act on them,” Tannenbaum concluded. “I think that's when we'll find the yield on this whole system.”

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