HHS Releases Proposals Seeking End to Information Blocking, Promoting EHR Interoperability

HHS Interoperability Proposal Would Name-and-Shame Info Blockers

The announcement comes on the first day of the Healthcare Information and Management Systems Society (HIMSS) conference in Orlando, Florida, where Verma is scheduled to speak Tuesday on interoperability and patient engagement. The proposed ONC rule would require that patient electronic access to this electronic health information (EHI) be made available at no cost. "The ONC rule puts in specific provisions or exceptions [to account] for privacy, security, and patient harm, but importantly makes pricing of this a reasonable set of pricing structures". The changes would also strengthen patients' access to their health information and reduce certain burdens such as tedious data entry for providers.

Policymakers have already been pushing healthcare providers to open up access to patient health records through reimbursement policy, but this long-awaited proposal goes even further in pushing the ball forward.

"We believe it would benefit patients and caregivers to know if individual clinicians, hospitals, and critical access hospitals (CAHs) have submitted a "no" response to any of the three attestation statements regarding the prevention of information blocking in the Promoting Interoperability Programs", CMS officials explained.

"These proposed rules strive to bring the nation's healthcare system one step closer to a point where patients and clinicians have the access they need to all of a patient's health information, helping them in making better choices about care and treatment", Azar said. CMS said provider burden would be reduced, and it would also "eliminate redundant procedures and testing, thus giving clinicians the time to focus on improving care coordination and, ultimately, health outcomes".

Last year, CMS launched a standardized API for Medicare fee-for-service plans, but is now looking to expand that effort to other government health plans by requiring programs to implement a HL7 FHIR-based API to open up data access to third party apps and developers.

APIs essentially serve as software adapters allowing for efficient transfer of health information across a variety of systems. "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".

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Payers in the aforementioned programs would also be encouraged to join a "trusted exchange network" that would allow them to participate in nationwide exchanges of data to promote interoperability.

Those organizations who choose to limit the availability and disclosure of electronic health records will be publically reported for "information blocking" as a way to incentivise better behavior. The rules, issued by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), would increase choice and competition while fostering innovation that promotes patient access to and control over their health information.

Interoperability as a standard for clinical data classes, as well as the required adoption of HL7 FHIR standards and implementation specifications meant to support API-enabled services.

Because different health care providers often use different communications systems, patient information is typically exchanged manually via fax, leaving room for human error during tedious and time-consuming data entry, according to a 2018 report by the National Association for Home Care & Hospice (NAHC).

In its proposed rule, ONC drew attention to the authority of the Office of the Inspector General (OIG) to issue civil money penalties for information blocking as well as "investigate health care providers for information blocking for which health care providers could be subject to disincentives". 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.

"By supporting secure access of electronic health information and strongly discouraging information blocking, the proposed rule supports the bi-partisan 21 Century Cures Act". "Electronic patient notifications are a proven tool for improving transitions of care between settings and improving patient safety", the CMS said in a summary of the rule.

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