The Healthcare Information and Management Systems Society (HIMSS) recently submitted suggestions to improve the proposed Centers for Medicare & Medicaid Services (CMS) prior authorization rule, with a focus on bolstering interoperability and patient access.

The current CMS proposal aims to simplify the prior authorization process, minimize administrative tasks, and enhance patient outcomes. However, HIMSS identifies areas that require further refinement to achieve these goals.

A key concern highlighted by HIMSS is the necessity for improved interoperability, which refers to the smooth exchange of data between distinct electronic health record (EHR) systems. Enhanced interoperability would allow healthcare providers to retrieve patient information more effectively, leading to well-informed decisions and shorter wait times.

HIMSS proposes that the CMS rule align with existing interoperability standards, such as Fast Healthcare Interoperability Resources (FHIR). Implementing FHIR would help healthcare providers adopt a consistent approach to data exchange, fostering efficient communication and collaboration.

Another critical aspect emphasized by HIMSS is the improvement of patient information access. The organization urges the CMS to reinforce provisions that support patients’ ability to access their health data. By granting patients access to their medical records, healthcare providers can encourage shared decision-making and enable individuals to actively participate in their health management.

Addressing privacy and security concerns related to data exchange is vitally essential. The organization suggests that the CMS implement robust privacy and security measures for data exchange under the prior authorization rule. This would protect patients’ personal health information and instill trust in the healthcare system.

HIMSS also advocates for provisions that encourage the utilization of Application Programming Interfaces (APIs). APIs facilitate the integration of various software applications, allowing healthcare providers to efficiently access and share patient data. By incorporating APIs into the prior authorization process, healthcare providers can optimize workflows and alleviate the administrative load related to prior authorizations.

Finally, HIMSS underscores the importance of continuous stakeholder engagement in the development and execution of the CMS prior authorization rule. Collaborating with healthcare providers, patients, and other stakeholders, the CMS can tailor the rule to address the healthcare community’s needs and enhance patient outcomes.

HIMSS presents valuable suggestions aimed at refining the proposed CMS prior authorization rule. By concentrating on interoperability, patient access, privacy and security, API incorporation, and stakeholder involvement, the CMS can improve the rule to effectively serve healthcare providers and patients.


Read More: HIMSS Written Comments