Interoperability and Patient Access & MRF
The Interoperability and Patient Access allows you to securely share your private health information and data.
As part of an effort to make it secure and easier for your healthcare providers such as your health plans, doctors, and facilities to access your private health records, the Centers for Medicare and Medicaid Services (CMS) has provided ways for all parties to work together in a standardized manner. This is called Interoperability and Patient Access rule.
What CMS Says About Interoperability and Patient Access
The Interoperability and Patient Access final rule (CMS-9115-F) delivers on the promise to put patients first, giving them access to their health information when they need it most and in a way they can best use it. As part of the MyHealthEData initiative, this final rule is focused on driving interoperability and patient access to health information by liberating patient data using CMS authority to regulate Medicare Advantage (MA), Medicaid, CHIP, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs).
Lack of seamless data exchange in healthcare has historically detracted from patient care, leading to poor health outcomes, and higher costs. The CMS Interoperability and Patient Access final rule establishes policies that break down barriers in the nation’s health system to enable better patient access to their health information, improve interoperability and unleash innovation while reducing the burden on payers and providers. Patients and their healthcare providers will have the opportunity to be more informed, which can lead to better care and improved patient outcomes, while at the same time reducing burden. In a future where data flows freely and securely between payers, providers, and patients, we can achieve truly coordinated care, improved health outcomes, and reduced costs.
What This Means for You and Your Health Plan
This set of regulations means that your health plan must make available all of your claims and clinical data contained in their systems using an API endpoint, which allows you to share your data with third-party applications of your choosing. Your health plan has contracted with 1upHealth, an industry leader in health care data integrations, and a cutting-edge data standard named FHIR, to give you access to your data and the ability to share it. When you want to integrate your healthcare data with third-party applications, such as MyChart, Apple Health, or FitBit, you can connect through these applications to the 1upHealth platform, where you confirm your identity to 1upHealth and your health plan by answering a few demographic questions and providing the email address that’s on file for you with your health plan. After your identity is authenticated, your health plan shares your health care data with the third-party application you have chosen, through the 1upHealth platform.
Patient Access API
If you use a mobile app or computer program to help you monitor your personal health goals, that app or program will request access to your health information. To provide a method for you to download or share your health information with apps and programs, we partner with 1upHealth for our interoperability solution. Interoperability is the process of enabling your health information to move seamlessly between our programs and the programs you select.
For more information about how interoperability functions and our responsibilities to meet your health data-sharing needs, you can review the following information.
Benefits and Risks of Sharing Data
There are many benefits to this new ability to access and share your data. You can review the 1upHealth Third-Party Applications page, for a list of the third-party applications that you can use to get this information. Some apps allow you to aggregate your data from multiple health systems to create a complete record of your interactions with different doctors and hospitals, and combine it with the data that you generate on your own from wearable devices, such as glucose meters, pedometers, or heart rate monitors. Some other common uses include prescription drug management, chronic disease management, nutrition tracking, and care coordination. Data sharing empowers you to have greater ownership of and visibility into your health data, and has the potential to improve both your health and the quality of care you receive from the health care system.
As with any interaction over the internet, these benefits are not without some level of risk. Your health plan takes your privacy and the security of your health information as seriously as you do. That’s why your data is never shared without your permission. Your health plan safeguards your data throughout the process of sharing it in several ways, including using challenge questions and multi-factor authentication to confirm you—and no one else—can access and share your data.
It’s important to understand that after your data is shared with a third-party application, your health plan is no longer responsible for the security of that data. That’s why it’s important to read the privacy and security policies for any application before you choose to share your data with it, to make sure that you understand how it is protected and used by that application.
App Developer Resources
Developers can use 1upHealth APIs to create applications that interact with CCHP’s electronic health data—including clinical and claims data—using the FHIR standard. 1upHealth provides a common RESTful API with access to 10,000+ health centers within their growing network.
1upHealth’s API fully supports FHIR® and provides rich programmatic access to electronic medical record data for patients and the companies and institutions who serve them. The available data includes patient demographics, labs, medications, observations, procedures, allergies, and much more.
The 1upHealth platform is HIPAA-compliant and is used by some of the largest hospital systems. You can get started for free with 1upHealth’s developer tier.
Login or Create a Developer Account
The following data is available through the CCHP/1upHealth FHIR API:
Patient Access and Provider Directory API Endpoints