June 10, 2021

CMS Interoperability Final Rule: How it Works and How to Comply

Stephen Kahn

Topic:   Industry Focus

Last updated: June 11th, 2021

Data access is a critical issue in patient care today. Most healthcare systems store patient data in different, unconnected systems. As a result, every service provider gets an incomplete picture of a patient’s health that denies physicians, pharmacies, and payers the chance to interpret data sets that are so critical to optimizing diagnosis and treatment.

The CMS Interoperability Final Rule aims to make it easier for healthcare consumers to access and share medical data. When enforced, the rule will allow patients to move from one service provider to another with their complete healthcare data. That way, patients, practitioners, and payers can make better decisions and improve their chances of achieving desired outcomes.

The healthcare interoperability rule will come into effect in July 2021. So, if you are yet to kickstart your compliance efforts, time is quickly running out. This blog explores the CMS Interoperability Final Rule and how data management technology can help you accelerate compliance.

What Does the CMS Interoperability Final Rule Entail?

The CMS rule issues guidelines that impact how patients, healthcare providers, and payers interact with patient health information. More specifically, the rule requires providers and payers to have application programming interfaces (APIs) that give patients access to their health data through third-party apps. This real-time access is meant to encourage patients to take charge of their healthcare.

The rule also requires practitioners to deploy infrastructure that gives them real-time access to a patient’s health information, regardless of who provided the care. This requirement accompanies policies that prevent care providers from restricting the flow of information to other practitioners. Additionally, practitioners must demonstrate that their systems can send electronic notifications to a patient’s primary caregiver or the next provider after discharging them from their facility.

For payers, the CMS Interoperability Final Rule requires developing APIs to make information readily available upon request. That way, existing members can change providers seamlessly, and prospective enrollees can know all about a plan before joining.

The Hurdles of CMS Interoperability Compliance

Bringing more transparency and standardization to medical data is a much-welcomed transformation for the industry. However, CMS interoperability compliance comes at a cost to the organizations it impacts. Healthcare providers and payers will have to bear the burden of building record management and information-sharing platforms that comply with the interoperability standards. According to the CMS, health plans could incur deployment costs of $700K to $2.3 million per organization.

Hospitals with robust electronic health records (EHRs) will find it easier to comply, but most will still need to upgrade or configure their systems to meet electronic notification requirements and guarantee security. The right data management techniques can help you get your organization in line quickly and cost-effectively.

Healthcare Data Management Technology to the Rescue

The primary requirement of interoperability is a single source of data that all authorized parties can access at will. Traditional electronic medical record (EMR) systems are adequate for handling patient records. However, to share the data with stakeholders outside the facility, authorized staff struggle to integrate other data management standards and protocols, which vary from one party to the next. Moreover, these systems cannot accommodate the all-inclusive API interoperability required for third-party mobile-app access.

A healthcare data management solution is the key to ensuring that critical information reaches patients, physicians, and payers on time and in the desired format. Today’s systems offer a secure, centralized data repository capable of getting information from various disparate systems and establishing the sharing channels required for CMS compliance. They also provide reliable healthcare data analytics to help you derive valuable insights from a wide range of data sets.

If you manage a healthcare practice or insurance facility, disseminating the information you have to customers and other organizations might sound like a daunting task, especially considering the short time left to comply with the CMS Interoperability Final Rule. Fortunately, with the right data management system, you can open your organization to interoperability in virtually no time.

Thinking Beyond Compliance

Some healthcare organizations may view the CMS Interoperability Final Rule as just another compliance project. However, in a broader and more impactful sense, it gives service providers a chance to acquire the wealth of data they need to perform in-depth analyses and make process improvements.

The CMS rule encourages the flow of data from multiple sources. More data means greater support for innovative approaches that improve care, patient experience, and health outcomes. So, take it positively, and invest in systems that maximize the value you get from data post-compliance.

TIBCO Omni-HealthData® is your one-stop solution for gathering, organizing, unifying, and sharing healthcare data ranging from disparate EHRs, cost, workforce, finance, and many other clinical and operational sources. Powered by artificial intelligence, the platform helps you replace traditional data management with an insights-driven system that delivers maximum value with minimum resources.

Visit our healthcare resource center to learn more about how TIBCO can help you comply with the CMS Interoperability Final Rule.

Download the whitepaper entitled “How to use EHR data to improve quality, efficiency and drive growth” to learn more today. If you are ready you can set up a time with Ask the Expert 


Steven Kahn, Director, Product Management for Omni Vertical Solutions at TIBCO, is responsible for designing the industry standards-driven models of our Omni Vertical Solutions. He also leads the team responsible for defining and creating the consumption, metric and presentation views, and industry metrics we offer in the verticals. Additionally, he and his team are responsible for creating and maintaining industry reference data content we provide to customers. He has spent nearly 40 years in the IT industry in roles from programmer through enterprise architect in Fortune 100 companies. His experience includes over 14 years in Big 6 consulting firms architecting solutions in industries such as healthcare, life sciences, pharma, telecommunications, high-tech, retail, CPG, financial, and many more.