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Challenges
- Patients find it extremely painful to constantly provide their medical information to multiple Providers. They also face difficulty accessing Patient information, inefficient medical and claim processes, managing care gaps and risks, and misdiagnosis.
- Payors are challenged by accessing Patient information across varying Providers, the lack of technical interoperability between Payors and other Payors, managing Patient care gaps and risks, data standardization, and data integrity.
- Providers are challenged by accessing patient information across varying Providers and Payors. They need to balance the pressures of providing the best care for Patients with the ever-increasing complexities of administrative, clinical, and regulatory standards, and requirements.
All of this results in poor Patient experiences and outcomes.
CMS rules, standards, and guidance
The U.S. government responded to interoperability and Patient access challenges negatively impacting Patient care outcomes by announcing that the CMS-9115-F ruling (CMS Interoperability and Patient Access) was to take effect in 2020 as part of the MyHealthEData Initiative.
- Payors are required to make a Patient’s claims and encounter data available to Patients in a user interface.
- They are also required to make a Patient’s clinical data available. This includes but is not limited to, conditions, medications, allergies, and labs.
- MA organizations, Medicaid FFS programs, CHIP FFS programs, Medicaid managed care plans, and CHIP managed care entities are required to make provider directory information available via the Provider Directory API. This API must be accessible via a public-facing digital endpoint on the Payor’s website.
- Part D Medicare Advantage plans must also make formulary information available via the Patient Access API. In addition, Medicaid and CHIP FFS and managed care must make preferred drug lists available.
For more information, you can check the CMS interoperability regulation guidelines.
Technology Stack Used
React & Angular
Material UI
Jest
React Testing
Library
AWS cloud
platform
JSON schema
tools
Samuel Salomon Levy Chief Executive Officer, Agnos
We are a global software development company that truly understands how to use the FHIR standard to improve interoperability among EHRs, devices, and information systems. We work passionately every day to boost the efficiency and productivity of operations and quality of care across the Healthcare ecosystem. The Agnos difference is our insatiable desire to marry our deep-dive healthcare industry and domain knowledge with truly world-class software delivery capabilities. It is our passion to "Co-Build" with our customers so that we build Better software Faster at the Lowest Cost possible... Together!
Samuel was a Partner and Managing Director at Accenture before he decided to lay the foundation of Agnos. Sam has over 24 years of technology consulting experience and has held senior-level positions at great companies like Unisys, Accenture, Microsoft, and IBM. Samuel has advised clients across a range of industries including healthcare, transportation, the financial-sector, high tech, and the federal government. His areas of expertise include Agile Software Development and Complex Project, Program, and Account Management.
