Interoperability takes center stage in the world of healthcare once again as both the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) propose new rules to increase patient and provider access to health records.
In a press release, the secretary of the U.S. Department of Health and Human Services (HHS), Alex Azar, said that these rules aim to take the nation’s healthcare system one step closer to giving patients and clinicians access to any and all of a patient’s health information that they might need. He added that this will also help physicians and patients make better choices about care and treatment.
“By outlining specific requirements about electronic health information, we will be able to help patients, their caregivers, and providers securely access and share health information,” Azar said in the release. “These steps forward for health IT are essential to building a healthcare system that pays for value rather than procedures, especially through empowering patients as consumers.”
ONC’s proposed rule aims to implement provisions in Title IV of the 21st Century Cures Act (Cures Act).
The CMS proposed rule requires all government health plans and all health plans offered through the Affordable Care Act provide patients with free control of and increased access to their HIPAA protected health information (PHI). If this rule goes into effect, issuers of these covered health plans would have until 2020 to comply with this proposed rule. The reach of CMS’ proposed rule could reach nearly 125 million patients.
APIs are key in both proposed rules
CMS’ proposed rule would require covered health plans to implement, test, monitor and maintain PHI application program interfaces (APIs). APIs are code that allow for two software programs to communicate with each other. This would make patient claims and other PHI available to patients through third party applications and developers. It would also simplify the process of transitioning between insurance plans and providers by helping patients access their information thereby easing the flow of PHI.
ONC’s proposed rule also attempts to increase healthcare interoperability through the use of APIs. However, ONC’s rule is more detailed than CMS’ rule. ONC’s rule proposes new API criteria that aims to standardize APIs throughout the healthcare industry. The rule lays out standards on data classification and other specifications for API-enabled access and services. Not only does this rule aim to increase the ability to share patient information but it also aims to make patient information available through mobile technology.
Don Rucker, M.D. and the national coordinator for health IT at ONC, said in the press release that, “by supporting secure access of electronic health information and strongly discouraging information blocking, the proposed rule supports the bi-partisan 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.”
Both rules address the issue of information blocking which is when a healthcare provider or vendor unreasonably constrains, or interferes with, the sharing of patient data or electronic health information. Examples of this include when a healthcare organization or vendor charges fees for exchanging information that make it cost prohibitive or when policies or contract terms are in place that prevent or dissuade the sharing of information.
CMS’ rule says that the agency would publicly post information about healthcare organizations that show they have been practicing some form of information blocking. This would apply to clinicians under the Merit-Based Incentive Payment System (MIPS), healthcare organizations participating in Medicare and Medicaid, and hospitals serving rural populations that are far from emergency care.
ONC’s proposed rule has additional requirements that focuses on preventing harm and promoting privacy. The rule also clarifies for providers and vendors what exactly constitutes information blocking and what does not.
Both CMS and ONC are currently accepting comments on these proposed rules and ONC is hosting a series of educational webinars about their proposed rule.