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States Select FHIR-based API to Meet CMS Interoperability Rule

To comply with CMS interoperability mandate, WA and MI integrated a FHIR-based API that provides Medicaid members access to personal health data.

Washington and Michigan have selected a secure application programming interface (API) to meet the CMS interoperability rule that Medicaid members have access to personal health data.

The CMS Final rule 9115-F requirements aim to empower Medicaid beneficiaries to make informed decisions related to their health and healthcare by ensuring portable access to personal health information and payer data.

Member data access must also follow the HL7 FHIR standard for the electronic exchange of healthcare information.

To fulfill these requirements, Washington and Michigan selected an interoperability solution from CNSI which provides members access to their personal health data through a secure API.

"Implementation of these rules is a natural evolution of all the hard work we have put into building out our MMIS system (CHAMPS) and statewide HIE infrastructure over the past 10 plus years,” Jason Werner, manager of the Medicaid EHR Incentive Program at State of Michigan, said in a press release.

“Medicaid beneficiaries are the real winners in all this as they will have access to their health information when they need it most and in a way they can best use it,” Werner continued.

The interoperability tool is set to provide patients with data regarding care encounters and claims, as well as a provider directory.

Christine Nolan, Washington Health Care Authority’s deputy chief information officer of Medicaid services, noted that this new integration will boost care coordination among the state’s Medicaid population.

"Washington is pleased to be able to give our clients access to their own health care data and allow them to share it with their care team to improve the coordination of their care," said Nolan. "This new development will enable the ProviderOne system to comply with CMS' patient access interoperability rules, furthering our vision of a healthier Washington."

Both states also use the vendor’s Medicaid Management Information System for provider enrollment and claims processing.

APIs, like the one in this latest deal, are important for enabling the seamless flow of medical information, experts say. If APIs were widely used in the healthcare sphere, patient data exchange and access to personal health data would grow, according to a report from Pew Charitable Trusts.

“If standard APIs were broadly adopted in healthcare, patients could access and compile their data from multiple providers while clinicians could process complicated information and make care recommendations,” the report authors wrote. “APIs would also offer other benefits, such as facilitating the exchange of clinical data among health care providers.”

Additionally, the Pew report noted that APIs allow healthcare organizations to incorporate clinical decision support (CDS) tools for prescribing antibiotics into provider workflows.

APIs also can allow providers to select the needed or important patient information to exchange, rather than sending the patient’s full clinical history.

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