By Hemant Taneja, Co-Founder of Commure and Managing Director of General Catalyst
When the 21st Century Cures Act passed in 2016, there was a strong sense of optimism. Key provisions of the Act had the potential to finally unleash the power of digital innovation in healthcare. You could see a world where patients would be back in control of their healthcare and personal data and physicians could return their focus to what they’d trained for — practicing medicine. It was in the halo of that optimism that we brought together top minds in technology, medicine, and design to build Commure.
Previously, in the absence of explicit regulation, legacy software infrastructure made it challenging for information to flow between health systems and other applications trying to create a better experience for patients and physicians. One consequence of this, familiar to most Americans, is the frustration that different doctors or hospitals treating the same patient cannot access all records for that patient. With the passing of the act, ONC promised to implement rules that would increase patient, clinician, and payer access to clinical data through APIs and sanction those that blocked information exchanges.
As both Eugene and I previously wrote about, we created Commure to enable thousands of developers to create the software that healthcare needs to drive positive health outcomes for millions of people. We and the health systems we worked with hoped that the eventual passing of the Cures Act would open the healthcare ecosystem and allow technology to transform the sector. So we built with that future in mind. We designed Commure from the ground up as FHIR-native with interoperability at its core to enable applications to access fine-grained data from any vendor while leveraging patient-facing APIs. We opened our Developer Platform, so that, once the final regulation was enacted, innovators would have tools immediately available to both develop and deploy applications. As we have seen in other industries such as travel, communications, and finance when technology and regulatory action work together they can spawn ecosystems of innovation that benefit all participants in the sector.
It took almost four years and thousands of comments and feedback from key stakeholders and the public, but this past Monday HHS released the long-awaited ONC Final Rule and CMS Final Rule. At a high level, the rules require payers and health systems to create secure, standards-based (HL7® FHIR version 4) APIs that allow patients the ability to access and control their electronic health information. Medicare Advantage (MA), Medicaid, CHIP, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs) that refuse to comply with these regulations will be subject to reimbursement cuts from CMS. The CMS rule specifically also requires electronic health records to provide clinical data necessary to enable new business models of care. The adoption of the U.S. Core Data for Interoperability (USCDI), which is a standardized set of health data classes and elements essential for seamless health information exchange, will assist in Commure’s mission to empower healthcare innovation.
As HHS Secretary Alex M. Azar stated: “These rules are the start of a new chapter in how patients experience American healthcare, opening up countless new opportunities for them to improve their own health, find the providers that meet their needs and drive quality through greater coordination.” The regulation is also life-changing for providers and health systems. They too will finally receive the applications and tools they need to drive better outcomes for their patients, and they will increasingly be unshackled from the time-drain that is current day EHR software. While more openness is required — including full read-write APIs, the Commure team is excited about the final rules issued this week and congratulate the visionary public sector leaders that helped lay the foundation for the next generation of healthcare.
As early adopters of the complete FHIR standard and interoperability, we’re proud to say that Commure fully supports all the technical requirements of the Cures Act. Healthcare systems who leverage Commure now have a way of securely exposing their data through modern APIs that satisfy all regulatory requirements. And any developers — whether internal hospital teams or third party vendors — interested in building compliant applications can easily do so on our Developer Platform.
Given that we’ve been building our company and technology for the past three years with this moment in mind, we’re already enabling USCDI clinical components and leveraging CMS’s Blue Button, BulkFHIR, and upcoming Data at the Point of Care workflows. For example, with Blue Button data from CMS, applications on our platform can derive as much clinical meaning from payers’ claims data to paint a holistic patient picture before a provider delivers care.
This platform is already live and operational in large, complex health systems, securely enabling FHIR APIs for all of their data to dozens of innovative applications. Most importantly, these applications are built into native EHR workflows as SMART on FHIR apps, where they, today, provide a fully integrated experience for providers. For more information, see our quick start guide on how to create these SMART on FHIR applications on Commure.
The next two years will see a burst of innovation in healthcare as technology finally becomes a leverage point for patients and providers. We’ve done early work at Commure laying the infrastructure for this evolution, and we’re eager to partner with and support those that are passionate about responsible software innovation for healthcare. If you’re as inspired by these new rulings and the opportunities they create as we are, develop on Commure or join our team!
Managing Director, General Catalyst