The healthcare industry is taking a significant leap towards new interoperability innovations with the CMS Interoperability and Patient Access final rule (CMS-9115-F). It finally addresses many of the problems associated with siloed healthcare data. While organizations need to comply with the rule by July 2021, CIOs should look at this as an opportunity to provide API-driven digital healthcare products and services as well as enhanced care. Siloed data prevents healthcare stakeholders from accessing important information to make timely decisions; this has become a global challenge in the healthcare industry. To overcome this and to become CMS compliant, most payers and providers are leaning towards API-driven, integrated healthcare solutions to achieve greater interoperability. This interoperability journey has to be well planned out and should be implemented with an industry-proven technology partner, who can help you to meet regulatory requirements as well as future digital transformation needs. In addition to the webinar, attendees can sign up for a complimentary two-week sandbox environment to test out features of the platform. Global interoperability challenges The CMS ruling, its impact, and why it matters to healthcare stakeholders How to prepare for CMS compliance, interoperability, and beyond How WSO2 can help you to become compliant with the CMS rule To view webinar on demand: https://wso2.com/library/webinars/healthcare-implementation-guideline-for-cms-rule/

1. Healthcare API Interoperability: An
Implementation Guideline for the CMS
Rule
November 04, 2020

2. Hello!
Glennon Dyess
Amanda Kothalawala
Senior Business Analyst - Solutions Architecture
amanda@wso2.com
Director - Solution Architecture
glennon@wso2.com

3. 3
- Isolated
- Disjoint
- Poor Communication
- Disconnect
- All Together
- Sharing
- Good Communication
- Interconnected

4. 4
Interoperability

5. 5
A standard driving the
new innovation of
interoperability
Fast Healthcare Interoperability
Resources (FHIR®) is a standard
describing data formats and
elements and an API for
exchanging electronic health
records.

6. The CMS Ruling and Its Impact

7. 7
The Interoperability and
Patient Access final rule
(CMS-9115-F) was introduced
by the Centers for Medicare &
Medicaid Services (CMS) to
enable better access to health
information for patients,
improve interoperability, and
unleash innovation. The
finalized new policies will be
enforced on July 1, 2021.

8. What Do These New Policies Mean?

9. ● Improve the usability of
electronic healthcare
records
● Enable physicians to
easily access and
search for patient
health records.
● Allows patients to easily
access their claims and
view information, via
third-party apps of their
choice.
● Make provider directory
information publicly
available via APIs.
● Exchange certain patient
data among the payers
at the patient’s request.
● Easy and secured
access to their EHRs on
their own electronic
devices.
● Better visibility and
transparency between
patients and providers.
● Ability to move from
one facility to another,
without spending time
and additional cost.
9
ProvidersPayers Patients

10. Who Does the CMS Rule Apply to?

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The payer provisions of the CMS rule apply to:
● Medicare Advantage (MA) plans
● Medicaid managed care plans
● Children’s Health Insurance Programs (CHIP) managed care plans
● CHIP state agencies (CHIP FFS)
● Qualified Health Plan (QHP) issuers on Federally Facilitated Exchanges (FFEs)
● State Medicaid agencies (Medicaid fee-for-service [FFS])

12. How to Prepare and Comply with the
CMS Rule

13. Challenges of CMS rule preparation
13
● Aggressive timelines
● Lack of clarity on compliance requirements
● Lack of in-house expertise
● Limited budgets
● Lack of a clear internal strategy beyond the CMS rule

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Analyze Compliance Readiness
Internal Processes, data, technical environments
Alleviate Data Mapping Risks
Contingency plan along with readiness and complexity assessments plans
Foresee Data Quality Issues
Data quality process teams in place
Evaluate Vendor Solutions
Purpose-built API integration platforms

15. API-Driven Healthcare Integration

16. Evaluate Vendor Solutions
● Will require different deployment options
⦿ Deployed on-premise, hybrid cloud, or multiple cloud environments
⦿ Deployed on bare-metal, VMs, or containers
● Healthcare API security through protocols such as OpenID Connect
● Advanced end-user Consent Management for apps and data
● Purpose-built API integration platforms provide capabilities as:
⦿ API marketplaces
⦿ API products
⦿ API monetization
⦿ Rate limiting
● Purpose-built Integration Engine that can handle current and future simple
or complex integration requirements 16

17. Healthcare Integration Solutions Vendors
● API integration solutions
● Niche solutions
● Hybrid solutions
17

18. API Integration Vendors Solution
● Ability to execute on Healthcare Solution
● Market presence in Enterprise Integration and API management
● Demonstrate past success with clients in the Integration and API market.
● Must be an experienced Healthcare Integration & FHIR®-focused teams to
support their API-driven Healthcare Solution
● API Integration vendors should include integration developers, professional
integration services, and integration support teams with a 24 x 7 x 365 model.
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19. Niche & Hybrid Vendor Solutions
● Niche Solutions
⦿ Specialized function
⦿ Built as need arises
⦿ Pose a risk due to lack of expertise
● Hybrid Solutions
⦿ Require different deployment options
⦿ Flexibility to run in on-premises, hybrid clouds, or multiple cloud
environments
⦿ Deployments on bare-metal, VMs, or containers.
19

20. When selecting a FHIR Server Solution
● What are the key questions you should ask?
● What features should you be concerned about when selecting a
Healthcare Integration Solution?
20

21. Core Capabilities you should look for in a FHIR Server
The three focus areas for core capabilities should be:
● API Management
● Application Integration
● Authentication and Authorization security
21

22. Key capabilities in an ideal FHIR® solution
22

23. How Can We Help You to Become
Compliant with the CMS Rule?

24. Introducing WSO2’s Open Healthcare Platform
● Built on top of our industry-leading, open-source integration platform
● API-driven interoperability
● Seamless and secure health data exchange
● Health data transformation with pre-built FHIR® accelerators for rapid
implementation
● Meets regulatory compliance requirements
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26. 26

27. Introducing WSO2’s Open Healthcare
Platform

28. How we can help you to become CMS Compliant
● We have partnered with some of the best healthcare domain knowledge
partners in the world
● By combining our world-class advanced security enforced API integration
technology and our partners’ healthcare domain knowledge and expertise
● Can provide you with a turnkey solution for the fast approaching Interoperability
and Patient Access final rule (CMS-9115-F)
● With our implementation timeline, we can have you compliant within three to six
months.
● Compliance with CMS-9115-F will lay the groundwork for future requirements:
⦿ Provide Directory API
⦿ Payer-to-Payer Data Exchange
⦿ and many others in the future
28

29. Call to Action

30. Resources
30
● WSO2 Healthcare vertical page: https://wso2.com/solutions/healthcare/
● Open Healthcare - Demo and Tryout: https://wso2.com/solutions/healthcare/
● Introductory session on WSO2 Open Healthcare:
https://wso2.com/library/summit-2020/americas/towards-greater-interoperabil
ity-with-a-proven-integration-platform-and-FHIR.
● Whitepaper on Healthcare API Interoperability - An Implementation Guideline:
https://wso2.com/whitepapers/healthcare-api-interoperability-an-implementati
on-guideline/

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32. Question Time!
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33. wso2.com
Thanks!
https://wso2.com/solutions/healthcare/