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Zyter Helps Healthcare System Comply with Mandated Patient Data Access Requirements

The Challenge

A major not-for-profit healthcare system with almost one million members enrolled in Medicare and Medicaid plans had to meet several compliance deadlines in 2021 and 2022. At the top of the list was adopting the requirements of the Interoperability and Patient Access final rule (CMS-9115-F) of the U.S. government’s MyHealthEData initiative.

As part of this initiative, the Interoperability and Patient Access final rule gives patients direct, secure access to their medical records anywhere, anytime, and on the patient’s preferred digital device. In addition, according to the United States Core Data for Interoperability (USCDI) provision, healthcare organizations and insurance payers must be able to exchange a member’s clinical data with another payer at a member’s request, thereby enabling members to take their personal clinical information with them as they move from payer to payer. Furthermore, healthcare insurance plans must incorporate prior payer data into current records they maintain for each new enrollee.

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To ensure compliance with these requirements and meet the first of several deadlines, this healthcare system needed to transform its IT infrastructure with new interoperability procedures and standards that would provide the necessary required secure visibility, access, and electronic exchange of member data. Specifically, this transformation would involve the implementation of patient access APIs to facilitate third-party apps to retrieve member data (adjudicated claims, encounter with capitated payment provisions, remittances, member cost share, clinical lab test results, preferred drugs, etc.) and provider directory APIs to publish provider data electronically by the July 1, 2021 deadline.

The healthcare system’s management considered interoperability solutions from several leading vendors, including Zyter. After several rounds of extensive evaluation and a complete overview of the technical, functional, security, and cloud-based aspects of Zyter’s end-to-end interoperability solution, management determined that Zyter CMS Interoperability™ stood apart from the competition as the best solution to fit their needs.

Zyter CMS Interoperability

The Approach

Zyter CMS Interoperability is a HIPAA-compliant, cloud-based software solution designed to enable health insurance payers to meet compliance deadlines for adopting the requirements of the Interoperability and Patient Access final rule (CMS-9115-F) of the U.S. government’s MyHealthEData initiative. The application solution securely connects multiple, disparate IT systems to ensure that payers can provide health plan members with the mandated real-time access and portability of their health records.

In a phased implementation over the next few months, Zyter will be opening up three specific APIs for peer-to-peer electronic exchange of Medicare and Medicaid plan members’ information. One API involves payers electronically transmitting patient data to another payer when patients switch payers for any reason. The second API enables peer-to-peer exchange of patient data between providers and payers, while the third API allows electronic sharing of the patient’s Medicare or Medicaid insurance information between payer and patient.

In Phase One of the project, Zyter will first ensure that the healthcare system meets the July 01, 2021 deadline for the electronic data sharing rule for Medicare and Medicaid patients. Zyter will build an interface of a file-based API that will collect the data from the healthcare system’s backend payer systems and push it out to various applications or receivers, such as application vendors, another payer, or another provider. For example, the API could push data to an application on an Apple Watch or on any mobile device that a plan member chooses to use. In subsequent phases, Zyter will implement additional APIs to meet additional CMS deadlines.

To save time and costs for the health care system, Zyter CMS Interoperability will provide the required standard Fast Healthcare Interoperability Resources (FHIR®)-compliant APIs out-of-the-box for fast deployment and immediate use. Additionally, Zyter’s interoperability solution resides on Zyter’s own HIPAA-compliant, micro services-based healthcare cloud platform that will integrate seamlessly with the disparate backend systems in the client’s enterprise. Zyter’s platform also supports multiple types of digital communication – email, video, chat, and more – using secure encryption so that all electronic data shared between the healthcare system’s insurance plans and its Medicare and Medicaid members will be in strict compliance with the CMS Final Rule.

The Results

Throughout all phases of the project, which is set to begin in February 2021, Zyter’s interoperability solution will give this healthcare system assurance that it will be in compliance with the CMS Interoperability and Patient Access Final Rule and will avoid any regulatory fines for missed deadlines. Ultimately, Zyter will provide all of the following technology benefits to its healthcare client:

  • Out-of-the-box connectivity to leading EHR, payer and provider systems
  • Complete FHIR solution with FHIR repository
  • FHIR 4.x support
  • Over 1,600 formats and data elements mapped to FHIR (as APIs)
  • Provider and payer data integration

Zyter’s interoperability solution will also enable the healthcare system’s Medicare and Medicaid plan members to access their personal data using their choice of Web-based payer portal or their preferred mobile app. As a result, they will be able to access their electronic health record (EHR) and all payer records and interactions anywhere and anytime they need them. Per the CMS mandate, data will be available electronically to plan members within one day of a claim adjudication, immunization, pharmacy or encounter. By giving members fast and easy access to plan data, the healthcare system will create an improved member experience that can drive member loyalty and satisfaction.

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