On December 10, 2020, the Department of Health and Human Services released a notice of proposed rulemaking Reducing Provider and Patient Burden by Improving Prior Authorization Processes, and Promoting Patients’ Electronic Access to Health Information, which builds on the Centers for Medicare & Medicaid Services’ (CMS) Interoperability and Patient Access final rule released earlier this year. This new proposed rule includes additional proposed requirements for payers to implement standards-based application programming interfaces (APIs) that can help address critical health care challenges such as improving the efficiency of prior authorization processes.

The Office of the National Coordinator for Health Information Technology (ONC) is working with CMS to ensure that APIs support the interoperable exchange of health data by proposing to adopt a series of cutting-edge implementation specifications developed through the HL7 Da Vinci project. These implementation specifications, which ONC has proposed for adoption by HHS in the new proposed rule, build on the HL7® FHIR® standard which ONC adopted in the 21^st Century Cures Act final rule released earlier this year.

It is important to note that ONC has not proposed any new or revised certification criteria. Nor have we proposed to require testing and certification to these implementation specifications as part of any existing certification criteria in the ONC Health IT Certification Program. However, we are eager to hear from providers, health IT developers, and other key stakeholders about how providers’ systems could evolve to take advantage of these new specifications.

ONC’s proposed adoption of these implementation specifications on behalf of HHS represents an important milestone in our continuing focus on increasing the interoperability of clinical and administrative data. Just last month, the Health IT Advisory Committee (HITAC) approved the Intersection of Clinical and Administrative Data (ICAD) Task Force’s report on the vital need to establish standards for prior authorization workflows, a key source of burden that continues to frustrate providers and contribute to inefficiencies in the health care system. The ICAD Task Force’s final report included discussion of several of the HL7 Da Vinci implementation specifications proposed by ONC in the new proposed rule. The task force noted that these implementation specifications could help providers seamlessly obtain coverage requirements and submit prior authorization requests directly from their EHRs.

ONC’s proposed adoption of these implementation specifications on behalf of HHS represents an important milestone in our continuing focus on increasing the interoperability of clinical and administrative data.

In addition to supporting more effective prior authorization transactions, the proposed implementation specifications cover other key areas. Certain proposed specifications focus on making administrative and clinical data available to both patients and providers, an essential step to improving the cost and quality of care, while others are designed to support seamless exchange of data between payers. The proposed specifications also support more robust care coordination by making provider directory information more easily available.

ONC’s proposal to adopt implementation specifications for health IT use cases beyond the ONC Health IT Certification Program is part of HHS’s broader commitment to advancing the interoperability of health information through aligned standards adoption. HHS’ adoption of these implementation specifications in a consistent manner, in one location, aims to ensure that they would be available to a wide range of stakeholders through HHS programs that choose to reference them as part of requirements for innovative health IT solutions.