Blue Shield of California pushes for greater interoperability

On June 25th, Blue Shield of California with a coalition of 50 national provider organizations and health plans, sent a letter to the Centers for Medicare and Medicaid Services (CMS) advocating for increased sharing of electronic patient records among providers. The letter came in response to a CMS request for feedback on proposed rules related to the sharing of information, otherwise known as “interoperability.” Additional signatories include care providers such as Cambia Health Solutions and Iora Health, as well as technology providers Elation Health and Intel.

The letter emphasizes several benefits of health data sharing including, enhanced patient care though real-time communication, prevention of unnecessary care, and the reduction of readmissions. It explained that given the currently fragmented system of information sharing, CMS is in a unique position to influence best practices moving forward through the adoption of regulations to standardize interoperability, specifically with regard to admission, discharge, and transfer (ADT) of information related to inpatient hospitalizations.

The coalition recommended CMS adopt the following requirements for ADT data sharing:

  • Presentation in Emergency Room/Admissions: A hospital must send real-time electronic notification that a patient has presented in the emergency room and/or been admitted to practitioner(s) responsible for the admitted patient’s care.
  • Discharge to Home: A hospital must send real-time electronic notification of discharge to practitioner(s) responsible for the discharged patient’s care. The hospital must also electronically send a copy of the discharge instructions and the discharge summary within 48 hours of the patient’s discharge.
  • Transfer of Patients to Another Health Care Facility: A hospital must send necessary medical information to the receiving facility at the time of transfer, and must send a real-time electronic notification of the transfer to the practitioner(s) responsible for the transferred patient’s care.

In addition, the letter urged CMS go further to direct information sharing.

“We believe that tying information sharing to Conditions of Participation would be a tremendous benefit to millions of Medicare and Medicaid patients across the country. In addition, we recognize that CMS has other levers that should be used to facilitate greater data sharing and interoperability, including requiring the use of 2015 Edition Certified EHRs and aligning requirements in the Quality Payment Program, the Promoting Interoperability program, and other quality programs such as STAR ratings. In addition to strengthening data sharing requirements in Conditions of Participation, we urge CMS to take additional action to align each of these programs with our national health care data and IT goals.”

Prior to joining the letter, Blue Shield demonstrated its organizational commitment to interoperability by announcing in March that it will require its network providers and ACO partners to participate in Manifest MedEx, a nonprofit health information network focused on creating comprehensive, real-time digital health records for Californians.