In an effort to implement part of the 21st Century Cures Act of 2016, the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS) released updated proposed rules to advance interoperability.
The proposed new regulations would empower patients and their caregivers with easier access to personal health information. The comment period for the proposed rule ended on June 3, 2019, with many positive comments, as well as some legitimate concerns from prominent healthcare organizations.
Proposed Rules’ Effect on Patients, Providers, and Payers
Some of the key points in the proposed rule include:
- Standards for patient access will be based on the new HL7 FHIR standard
- Hospitals must communicate ADT e-notifications for every admit, discharge, transfer
- Payers must embrace the new HL7 FHIR standard as well
- Claims data is to be provided to patients for Medicare Advantage, Medicaid, CHIP, and qualified health plans using APIs
- A payer provider directory with electronic routing addresses will be made available by HHS through an API
Having a centralized directory of providers that contains electronic addresses would be an important step in fostering communications across the patient continuum of care, regardless of where the patient decides to continue their care. To encourage full participation in this directory, CMS will publicly report any providers that have not added digital contact information — a way of driving participation through public shaming.
In addition, the proposed rule accelerates work on patient matching strategies and promotes wider adoption of interoperable healthcare IT systems in long-term post-acute care, behavioral health, and home services.
Strengthening Rules Around Information Blocking
One thing that has been top-of-mind at the ONC for many years is the idea of eliminating what it sees as information blocking practices. Information blocking has received a lot of press in the past, with various parties standing their ground about who is really responsible for the lack of patient data sharing. The proposed rule dedicates a lot of attention to this topic.
The proposed rule prohibits vendors from charging any API technology related fees except as those permitted: such as fees to develop, deploy, or upgrade API technology, and of course applicable fees to support it. No fees can be charged that are related to patients. API users cannot be charged except for value-add services.
Providers themselves must be equipped to share health information in real time at no cost. There are also additional measures to provide assurances that a healthcare IT developer does not take any action that may inhibit appropriate exchange, access, and use of electronic information.
Timeframe for Proposed Changes
In conjunction with the proposed rule, the CMS has issued a roadmap that summarizes the timeframe for implementation of these requirements.
One of the first things that the CMS wants to put into place is the payer provider directory, which will make the electronic addresses of everyone available for exchange. This is slated for 2020, a short timeline given we are already half way through 2019.
Toward the end of the list are the e-notifications for ADTs. But given the technology enhancements that providers might need to make to deliver this functionality, this is considered to be an aggressive timeline as well.
Support and Apprehension for Proposed Rule Changes
Feedback from across healthcare IT has been both supportive and apprehensive. The six former heads of the ONC applauded the proposed rule. They specifically point to API usage, the HL7 FHIR standard, e-notifications, and rules against information blocking as important to moving healthcare interoperability forward.
However, several groups were apprehensive, particularly around the timelines. Members of the HIMSS EHR Association were supportive overall, but cautioned against loosely defined requirements as well as the timeline. The Medical Group Management Association (MGMA) was also concerned about the timeline said the proposed rule goes "too far, too fast."
Corepoint’s Perspective on Proposed ONC, CMS Rule Changes
Corepoint Health agrees fully with the heart and mission of the proposed rule. For more than 20 years, Corepoint Health has been at the center of healthcare data exchange, solving workflow requirements that enable customers to provide better patient care.
While the timelines for the proposed rule are tight, Corepoint Health looks forward to assisting our customers in meeting these goals. As with the various stages of Meaningful Use, where timelines were always tight, the ONC and CMS were fair in issuing extensions where timelines became unrealistic. Through continued industry feedback, the same type of give-and-take can continue to work to the benefit of the industry moving forward.