Last Updated: Mar 7, 2019
Two new proposed rules announced by the U.S. Department of Health and Human Services (HHS) on Feb. 11, 2018 seek to enhance electronic health record (EHR) interoperability, prevent data blocking, and allow patient access to electronic health information at no cost.
The Centers for Medicare and Medicaid Services' (CMS) proposed rule would require that federally-funded exchanges – Medicaid, the Children’s Health Insurance Program, Medicare Advantage plans, and Qualified Health Plans – must provide enrollees with immediate electronic access to medical claims and other health information electronically by 2020. This change, if implemented, would affect approximately 125 million beneficiaries.
Some of the additional provisions in CMS’ proposal include:
- Publicly sharing information on health care organizations and clinicians that are engaging in data and information blocking
- Publicly reporting the names and National Provider Identifiers (NPIs) of those providers who have not added digital contact information to their entries in the National Plan and Provider Enumeration System (NPPES) beginning in the second half of 2020. The NPPES has been updated in response to a mandate in the 21st Century Cures Act requiring a provider digital contact information index.
- Proposing to require as a condition of participation (CoPs) for hospitals and critical access hospitals (CAHs) to electronically send “patient event notifications”, otherwise known as an admission, discharge, transfer (ADT) notification, to a patient’s physician or health care provider.
The CMS proposal also includes two requests for information (RFI) on:
- Information on how a provider could download data from payers on a shared patient population through the use of an application programming interface (API).
- CMS is seeking proposed action addressing the use of an algorithm or software to aid in the improved process of patient matching in order to advance care coordination and interoperability.
The other proposed rule, issued by HHS’ Office of the National Coordinator for Health Information and Technology (ONC), is a complement to the CMS’ proposal, tackling health IT interoperability infrastructure specifically taking aim at the technical and workflow barriers that limit the patient, provider and payer from accessing health data when it is necessary. It calls on the health care industry to adopt standardized APIs to help users easily and securely access and exchange electronic health information between systems whether it is a smartphone, mobile application, or an EHR. Additionally, the ONC’s proposed rule includes an information blocking provision with certain exceptions for reasonable and necessary practices like protection of patient privacy.
The ONC proposal also includes RFIs, seeking additional understanding of patient matching, as well as price transparency and information blocking and how to expand price information to the public, including patients, plans and providers of health care.
Key recommendations found in both rules should offer benefit to EHR end users as proposals ask for expansion of data EHRs deliver to physicians and patients; vendor oversight, fee limitation, and information blocking condition of certification; real world testing; and the adoption of modern interoperability standards.
The proposals were published online via the Federal Register on Mar. 4, 2019. Public comments are due June 3, 2019. Comments on the CMS proposal can be submitted here, and comments on the ONC’s proposal can be submitted here.
You can find more information on the proposed rules via these links: