The Bumpy Ride of Interoperability and Electronic Prior Authorization | AMCP Nexus 2022

No one seems to disagree that data ought to flow more freely through the U.S. healthcare system and that processes like prior authorization should happen faster and be more automated

But in a session today at the AMCP Nexus 2022 meeting, Kim Boyd sketched a complex picture development of technology standards and statutory and regulatory history. 

Kim Boyd

“The path to interoperability and specifically to PA (prior authorization) improvement and automation, data and cost transparency is one that has lots of curves, speedbumps— and a lot of roadblocks,” said Boyd, who is senior consultant, regulatory resource center lead for Point-of-Care Partners, a healthcare IT management consulting company in Hollywood, Florida.

But Boyd also spoke about a “crescendo of polices and standards” to improve interoperability — the ability of different healthcare IT systems and devices to communicate with each other — and patient empowerment.

Boyd traced the legislative and regulatory history of interoperability and electronic prior authorization back to the 21st Century Cures Act. Federal action went into something of a lull during the height of the COVID-19 pandemic, Boyd said, so many states have stepped in with laws or rules concerning data-sharing.

Boyd also described the prominent role of the standards development organizations,such Health Level 7, which developed the Fast Healthcare Interoperability Resources (FHIR) standard — referred to almost exclusively by its acronym, FHIR (pronounced fire). She also mentioned the National Council for Prescription Drug Programs and X12.

Boyd noted the growing role of specialty medication in healthcare and the difficulties it poses for streamlining and automation.

“Specialty pharmacy today has no clear or consistent entry point to automation,” Boyd said. “The current state of specialty prescribing drives us to use portals, web searches, cheat sheets and binders.”