HHS unwraps long-awaited new information blocking rule

A new rule issued today by the Office of the National Coordinator for Health Information Technology involves the patient, not as a person being “acted upon,” said Elise Sweeney Anthony, director of Office of Policy for the ONC, but as someone in control of his or her electronic health records.

If a patient requests their record, and it’s not given to them electronically and for free, that’s information blocking, Sweeney said during HIMSS19.

The Centers for Medicare and Medicaid Services would also require that healthcare providers and plans implement open data sharing technologies to support transitions of care as patients move between these plan types.

For instance, the records must be able to be transferred between providers when a patient requests that service when changing physicians.

Health information exchanges and health information networks are subject to penalties of up to $1 million for lack of interoperability. There’s no longer an excuse of distrust in data sharing.

“If everyone is working from same agreement, those concerns evaporate. “That is breaking down the silos,” Sweeney said.

Providers are not subject to fines, but CMS could impose “appropriate disincentives,” ONC said.

The ONC has included in the conditions of certification that healthcare IT developers need to publish application programming interfaces (APIs) without special effort.

The ONC’s proposed rule calls on the healthcare industry to adopt standardized APIs, which will help individuals securely and easily access structured and unstructured EHI formats using smartphones and other mobile devices.

It also implements the information blocking provisions of the 21st Century Cures Act, including identifying reasonable and necessary activities that do not constitute information blocking.

“Having just read over the rule and looked at the summary sheets, what you see is it’s a very thoughtful set of expectations,” said Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center. “We know that information blocking is often a misalignment of incentives, so it actually does allow us to consider things like cost and difficulty and burden. In effect, what it does is to remove arbitrary blocking and gives us a guideline (to move forward). And that’s really a great approach.”

The proposed rule also asks for comments on pricing information that could be included as part of their EHI and would help the public see the prices they are paying for their healthcare.

Policies in the proposed CMS and ONC rules align to advance interoperability in several important ways. CMS proposes that entities must conform to the same advanced API standards as those proposed for certified health IT in the ONC proposed rule, as well as including an aligned set of content and vocabulary standards for clinical data classes through the United States Core Data for Interoperability standard.

The ONC is working closely with the Centers for Medicare and Medicaid Services on the interoperability rule.

“It’s not just about quality payment programs, it’s not just about MACRA,” Anthony said. “It allows us to think about the care continuum.”

The rule for 2020 applies to Medicaid, the Children’s Health Insurance Program, Medicare Advantage plans and health plans in the Affordable Care Act federal exchanges.

So far, the  money for IT implementation has gone to the top spenders such as hospitals and ambulatory care, according to Dr. Terrence Omalley of the Partners Healthcare System. The less expensive care settings, such as home health, have gotten virtually nothing.

“All of the health IT resources are on top,” he said.

CMS’ proposed changes to the healthcare delivery system support the MyHealthEData initiative and follow regulations released by CMS in 2018

finalizing regulations that use potential payment reductions for hospitals and clinicians to encourage providers to improve patient access to their electronic health information.

“Today’s announcement builds on CMS’ efforts to create a more interoperable healthcare system, which improves patient access, seamless data exchange and enhanced care coordination,” said CMS Administrator Seema Verma. “By requiring health insurers to share their information in an accessible format by 2020, 125 million patients will have access to their health claims information electronically.”

“By supporting secure access of electronic health information and strongly discouraging information blocking, the proposed rule supports the bipartisan 21st Century Cures Act. The rule would support patients accessing and sharing their electronic health information, while giving them the tools to shop for and coordinate their own health care,” said Dr. Donald Rucker, National Coordinator for Health IT. “We encourage everyone – patients, patient advocates, healthcare providers, health IT developers, health information networks, application innovators and anyone else interested in the interoperability and transparency of health information – to share their comments on the proposed rule we posted today.”

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