The Information Exchange: CMS Rules, Data Standards, and Platform Futures
The Information Exchange: Russian Dolls and Headless Tractors - Health API Guy
Summary
Multiple critical trends in US healthcare IT were reported, including the CMS-0062 launch and ACCESS. Key focus areas include the complex system structure of payers and regulatory conflicts over data standards like FHIR/X12.
Details
This article details how the new CMS-0062 drug rule is bigger than just a pharmaceutical regulation, potentially conflicting with existing prior authorization rules. It highlights the structural problem that payer systems are like 'Russian dolls,' containing multiple claims systems under one name. Technically, it points out contradictions: while CMS-0062 recommends FHIR Da Vinci for prior auth, older rules (0053) allowed X12 for attachments. Furthermore, a proposed RFI regarding certifying payer technology (a return of HTI-2) is discussed, raising concerns about potential information blocking risks. The John Deere 'right to repair' case connects platform dependency in medical devices and record systems to broader antitrust issues. Finally, using Salesforce's opening of its UI/API layer as an example, the article discusses the shift towards an 'agent economy' in healthcare IT and the commoditization of front-end interfaces.
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