How Public Input Could Shape Healthcare Interoperability
With the increasing calls for transparency, patient access, and value-based care, The Centers for Medicare & Medicaid Services (CMS) has made an announcement seeking public input on improving healthcare interoperability aiming to identify and resolve the technical and operational barriers that prevent seamless healthcare data exchange.
This blog explores CMS’s announcements, the importance of interoperability, actionable steps to achieve it, and how public feedback can drive meaningful change for healthcare professionals.
What is Interoperability in Healthcare?
Interoperability in healthcare not only means exchanging of data across various organisation but it also involves interpretation and usage of the shared data effectively and securely. It helps in establishing a seamless communication among the healthcare providers, payers, and patients by enabling them to access and act on health data regardless of where or how it was generated.
There are four recognized levels of interoperability:
- Foundational level where systems can exchange data such as transferring patient records, public health information between Electronic Health Records(EHRs).
- Structural level in which the data exchange follows a consistent standardized formatting like Fast Healthcare Interoperability Resources (FHIR), allowing systems to interpret data uniformly.
- Semantic level in which the formatted and exchanged data can be used in the same way across systems, using standardized common vocabularies like coding using ICD-10. This allows systems can interpret and use the exchanged data meaningfully.
- Organizational level which includes governance, policies, and legal frameworks that support collaboration across organizations.
What are the benefits of healthcare data exchange?
- ✔ Effective data exchange can help healthcare providers to take informed and timely decisions.
- ✔ By gaining access to the patient's electronic medical record, physicians can easily make faster diagnoses and customized treatment plans.
- ✔ By automating data exchange, we can lower the administrative costs and save time.
- ✔ Sharing Clinical data with various information system can eliminate the need for taking redundant tests and procedures thereby improving operational efficiency and patient care.
- ✔ It also improves the real-time communication between primary care physicians, specialists, hospitals, and other providers.
Adopting robust data exchange practices is essential for achieving these benefits. The role of technology in data exchange is inevitable. Innovations like APIs and secure cloud services enhance the sharing of healthcare data. Overall, effective data exchange is a pillar of modern healthcare interoperability.
At Shoreline Medical Billing, we leverage interoperable systems to streamline data exchange between providers and payers, improving reimbursement efficiency and reducing administrative burdens.
What are the recent announcements made by CMS on Healthcare Interoperability?
In partnership with the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC) the CMS had released a Request for Information (RFI) in May 2025. The main objective of the initiative was to gather public opinion on providing a seamless, secure, and patient-centered digital health infrastructure.
Key initiatives announced by CMS include:
- Developing a centralized and an automated National Provider Directory to improve the data accuracy and to reduce the administrative burden on providers and payers.
- Implementation of Modernized Identity Verification by streamlining the credentials on Medicare.gov to enhance security and interoperability across systems.
- Expansion of the initiative Blue Button 2.0 to provide Medicare beneficiaries with secure access to their health data via third-party applications.
- Sharing claims data directly with providers using FHIR-based APIs to make it available at the point of care.
- Promoting the participation in TEFCA (Trusted Exchange Framework and Common Agreement) for providing a universal framework for secure and bi-directional data exchange.
- Additionally, as per the CMS’s 2024 Interoperability and Prior Authorization Final Rule (CMS-0057-F) all Medicare Advantage, Medicaid, CHIP, and Qualified Health Plans (QHPs) were asked to adopt the FHIR-based APIs for data exchange and prior authorization processes.
Why Public Input Matters in Shaping Interoperability?
- ✔ Getting opinion from the public is essential in addressing the real-world challenges faced during the healthcare data exchange. The main stakeholders in healthcare industries are the providers, payers, patients, and technology companies and hence getting their ideas can help to identify the barriers to bringing interoperability into full operation.
- ✔ Incorporating the feedback given by the public can lead to more patient-centered systems. By understanding the patient priorities, we can ensure that the data exchange is both functional and user-friendly. Thereby enhancing the satisfaction and engagement levels of the patients.
- ✔ Transparency can be enhanced by public involvement. It creates trust in the healthcare systems among communities.
What are the challenges in achieving effective Interoperability?
Numerous barriers hinder in achievement of healthcare interoperability. Recognizing them is essential for developing robust solutions.
- ✔ Data Privacy and security
- ✔ Inconsistent data standards and formats
- ✔ Complexity in system Integration
Data Security and privacy:
One of the significant challenges, would be safeguarding the patient's privacy and data protection while ensuring the accessibility across the various networks.
Inconsistent data standards and formats:
Each system may have its formats and standards, and this inconsistency complicates smooth data exchange and integration.
Complexity in System Integration:
Integrating various systems across the networks requires significant effort and technical expertise. It might also demand high financial resources.
How can these interoperability issues be resolved?
We must adopt a cooperative strategy including all stakeholders to address these issues.
- Secure data interchange will be made possible by CMS's mandated adoption and implementation of FHIR-based APIs.
- Joining in networks like TEFCA, a universal framework for secure, bi-directional data exchange across health information networks (HINs).
- Implementing robust cybersecurity measures, such as encryption and modern identity verification, to protect patient data during exchange.
We at Shoreline Healthcare Technologies have
- ✔ Integrated FHIR-compliant systems into our billing workflows, ensuring accurate data exchange between providers and payers.
- ✔ Our systems align with TEFCA standards, enabling clients to participate without workflow disruptions.
- ✔ We prioritize HIPAA-compliant data handling, ensuring secure billing and claims processes.
- ✔ We offer training to help clients navigate across interoperable systems, ensuring compliance and efficiency.
- ✔ We always stay updated on CMS policies, helping clients adapt to new interoperability requirements.
- ✔ By integrating with emerging directories, we ensure accurate provider data for billing and reimbursement.
- ✔ By Adhering to CMS interoperability rules we try to avoid penalties and help in getting accurate Medicare and Medicaid reimbursements.
At Shoreline Medical Billing, we assist medical practitioners with interoperability implementation, claim streamlining, denial reduction, and CMS compliance. Our advanced billing solutions guarantee prompt payouts by integrating easily with payer platforms and EHRs.
With Shoreline as a reliable partner, healthcare practitioners may completely experience the benefits of interoperability by overcoming these challenges.
From small clinics to immense hospital systems, we customize billing services to meet the needs of your practice.
Sharanya Rajmohan
Content Writer
Sharanya brings clarity to the complexities of medical billing and healthcare regulations. With a knack for turning industry shifts into straightforward, actionable insights, her blogs help readers stay informed without the jargon.
Shape the Future of Interoperability. Ready to streamline your billing with interoperable solutions? Contact Shoreline Medical Billing today.