CMS and ONC Propose New Rules to Improve Interoperability of EHI

"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", HHS Secretary Alex Azar said in a statement. The changes would also strengthen patients' access to their health information and reduce certain burdens such as tedious data entry for providers. "We can not build a value-based healthcare system without value-based information technology", said Eric D. Hargan, HHS deputy secretary. 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. "For the first time, CMS is now proposing requirements that Medicaid, the Children's Health Insurance Program, Medicare Advantage plans and Qualified Health Plans in the federally facilitated exchanges must provide enrollees with immediate electronic access to medical claims and other health information electronically by 2020", the agency noted.

Healthcare's holy grail of interoperability has always been an overarching priority for policymakers looking to leverage the untold data silo'd away in EHRs and other systems. CMS said the change would affect 125 million patients, and possibly more if insurers implement the same system for commercial clients. "The rule would support patients in accessing and sharing their electronic health information while giving them the tools to shop for and coordinate their own healthcare". Second, each exception is meant to address a significant risk that regulated individuals and entities (i.e., health care providers, health IT developers of certified health IT, health information networks, and health information exchanges) will not engage in these reasonable and necessary activities because of potential uncertainty regarding whether they would be considered information blocking.

"For far too long, electronic health information has been stuck in silos and inaccessible for healthcare consumers. It belongs to patients".

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". "They're answering a Yes or No question on this, and if they answer Yes. we will be publishing that data".

"By supporting secure access of electronic health information and strongly discouraging information blocking, the proposed rule supports the bi-partisan 21 Century Cures Act".

The proposal calls on the health care industry to use standardized formats, or "application programming interfaces (API)", that are compatible with smartphones.

"We believe that obtaining their health information should be just as convenient, easy and user-friendly", Ms. Verma said. The CMS rule also proposes to publicly name providers or hospitals that participate in information blocking, or practices that limit the sharing of electronic health information; CMS said this could lead to practices to refrain from limits. On the other hand, the rule would not require a hospital to notify a provider that the patient is in the emergency department, or has been admitted, which were 2 of the suggestions made by the National Association of Accountable Care Organizations in a letter sent to CMS previous year. What this allows the patient to do is to aggregate all that data; because it's going to be in API format, they can take that information and potentially aggregate that into one place. Aligning these requirements for payers, health care providers, and health IT developers will help to drive an interoperable health IT infrastructure across systems, ensuring providers and patients have access to health data when and where it is needed.

HHS "put in a lot of provisions to ensure security and privacy for patients, in that work to get it on the smartphone", said Rucker.

CMS has long sought to advance policies meant to open up patient control of their healthcare data. "This proposed rule will stop that". "We think both of our rules will strike a blow to get transparency for the American public". The other part is pricing information.

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