AMIA: CMS is ‘too aggressive’ on API timeline for health plans

The American Medical Informatics Association is warning the federal government to go slow in requiring federally funded health plans to use open application programming interfaces.

AMIA contends that demanding health insurers hit a rigid deadline for using APIs to share data with members will be nearly impossible for them to achieve.

Last February, under the Interoperability and Patient Access Proposed Rule, the Centers for Medicare and Medicaid Services called for Medicare Advantage (MA) and Qualified Health Plans (QHPs) to have APIs in place by January, and for Medicaid and Children’s Health Insurance Program (CHIP) agencies to have them in place by July 2021.

In a June 4 comment letter to CMS, Douglas Fridsma, MD, president and CEO of AMIA, and Peter Embi, MD, AMIA’s board chair, said they support the proposal for the use of open APIs, but warned that the timelines are “too aggressive” to be feasible. AMIA represents 5,600 biomedical and health informatics professionals from more than 65 countries.

For a long time, APIs have been considered the next best hope for achieving interoperability. In its February proposal, CMS said it is looking for ways to make patient data more useful and transferable, while reducing burdens on healthcare providers.

AMIA points out several sticking points in the proposal. Namely, the new data standards proposed by the Office of the National Coordinator for Health IT (ONC) will be required by January 2020, but ONC is not expected to require certified health IT to generate such data until January 2021 at the earliest.

In addition, AMIA says there is currently industry-wide inconsistent adoption and use of data, especially for laboratory results, drug benefit data, pharmacy directory information and formulary data.

As a proposed solution, AMIA recommends that CMS use a phased approach for health plan API adoption, beginning in July 2020. The first phase would include implementation of claims and encounter data; followed by a second phase of clinical data and lab results; and lastly, drug benefit, pharmacy directory and formulary data.

In addition, “CMS may want to consider the use of ONC’s Certification Program to align standards and implementation decisions across stakeholders who generate and use these datatypes,” AMIA said.

“We applaud CMS for their proposals to improve beneficiary access to health plan data,” Embi said. “But we must install deliberate processes and sensible timelines to ensure these data are useful for beneficiaries.”

CMS’s proposal also included several Requests for Information (RFIs) on how to improve adoption and interoperability in long-term care and post-acute care settings. To these, AMIA recommended that CMS develop models that promote interoperability and advance health IT, in addition to funding ACGME-accredited Clinical Informatics fellowships.

“Structural and specified funding mechanisms for the training of Clinical Informatics fellows is necessary for CMS to attain stated goals for improved interoperability and use of data for patient care,” AMIA said.

CMS’s proposal also called for hospitals to make available electronic notifications of a patient’s admission, discharge or transfer to another healthcare provider. AMIA recommended caution here, as well, saying CMS should wait until it gains insights from the finalization of the Information Blocking Rule, before proceeding—in addition to taking stock of stakeholder feedback over the next payment year.