Patient Access API
Patient Access Application Programming Interface
Patient Access API allows for patients to access their health and administrative information through third-party applications of their choice, through a FHIR-based API.
The CMS Interoperability and Prior Authorization Final rule requires payers to make claims, encounter, clinical, and prior-authorization data accessible to patients through a secure FHIR-based API.
Patient Access API is designed to provide real-time access to healthcare information. It aims to improve satisfaction, lower costs, and reduce administrative burden. With this API, patients are given their healthcare information in the third party app of their choice, which enables them to make more informed decisions.
Benefits of Patient Access API
- Real Time Access: Patients can access their healthcare information in real time.
- Improved Data Sharing: The API facilitates the exchange of data of clinical data, claims, and coverage details, allowing for a continuity of care when patients change insurance providers.
Tips for selecting a Third-Party Digital Application
- Third party applications can be accessed through App Stores.
- Always review the apps privacy policy and Terms of Use/Terms of Service before agreeing to use an app.
Things to consider with 3rd-party applications:
- What types of data will this app collectâincluding health and non-health data like location?
- How will my data be stored (e.g., de-identified, anonymized)?
- How will the app use my data?
- Will the app disclose, share, or sell my data to third partiesâfor purposes such as advertising or research? If so, with whom and why?
- How can I limit the appâs use and disclosure of my data?
- What security measures does the app use to protect my data?
- Will the app delete my data after I stop using it?
- What impact could sharing my data with the app have on others, such as family members?
- How can I access my data and correct any inaccuracies?
- If I stop using the app, how do I revoke its access to my data?
- Does the app have a process for handling user complaints?
- How does the app notify users about changes to its privacy practices?
Additional Considerations:
- The Health Plan is a covered entity under the Health Insurance Portability and Accountability Act or HIPAA. Individuals have certain rights under HIPAA which are explained in The Health Planâs Notice of Privacy Practices. These rights include the right to access your health information and the right to file a complaint. HIPAA regulations are enforced by the U.S. Department of Health and Human Services Office for Civil Rights.
- Most third-party apps are not regulated by HIPAA. Most third-party apps are instead regulated by the Federal Trade Commission or FTC. Because third-party apps are not regulated by HIPAA or The Health Plan, it is important that you take an active role to protect your health information when choosing an application. Remember, The Health Plan does not control the third-party application. The third-party app you use to access your information through the patient access API is up to you. As a result, you should be careful when selecting a third-party app with which to access your information.
- You should only use apps that you trust. You should read and understand the appâs privacy policies before accessing your information using that app.