Healthcare is all about providing better care to patients, and both healthcare providers and patients stand to greatly benefit from an interoperable health IT environment. The Cures Act was designed to make this interoperable healthcare environment a reality, and help health IT stakeholders prevent Information Blocking. To attain the vision behind the Cures Act, and deliver better-coordinated care to their patients, healthcare providers need to have a thorough understanding of the various aspects surrounding the Cures Act and other Information Blocking criteria.
What is Cures Act?
Cures Act was signed into law on December 13, 2016, to improve innovation in healthcare technology to deliver better information, more conveniently, to patients and providers. After the Cures Act was signed into law, the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS) came up with two sets of rules in 2020 (Cures Act Final Rule) based on the Cures Act’s interoperability, patient access, and information blocking provisions. These rules further define guidelines for providers, payers, and health IT vendors.
These include provisions for advancing interoperability by requiring Health IT developers and Providers not to engage in Information Blocking by preventing or interfering with the access, exchange, or use of Electronic Protected Health Information (EHI).
What is EHI?
EHI is individually identifiable health information that is maintained or transmitted electronically. It includes medical records and billing records of a provider about individuals that are used by providers to make decisions about individuals. Providers need to make full EHI available from October 6, 2022. Read More About EHI
What is Considered Information Blocking?
Any effort by a provider, or their office that would interfere with, prevent, or materially discourage a patient’s Access, Exchange or Use of their electronic protected health information on a timely basis constitutes Information Blocking.
Eight Information Blocking exceptions were established in the 2020 Cures Act Final Rule. When a provider’s practice meets the condition(s) of an exception, it will not be considered information blocking. Read More About the Information Blocking Exceptions
To Whom Does the Information Blocking Rule Apply?
The Information Blocking regulations apply to:
Healthcare Providers of all kinds
Health Information Technology Companies
Health information Networks (HINs) or Exchanges (HIEs)
These entities are considered "Actors".
Information Blocking Actors
ONC’s Information Blocking Actors
Health Care Providers* that see patients at any point of service, including Telemedicine. You are probably a healthcare provider if you can find yourself on the list:
Hospital
Skilled Nursing Facility
Nursing Facility
Home Health Entity or other Long Term Care Facility
Health Care Clinic
Community Mental Health Center
Renal Dialysis Facility
Blood Center
Ambulatory Surgical Center
Emergency Medical Services Provider
Federally Qualified Health Center
Group Practice
Laboratory
Pharmacist / Pharmacy
Physician
Practitioner; provider operated by or under contract with the India Health Service or by an Indian tribe, tribal organisation, or urban Indian organisation
Rural Health Clinic
Covered Entity under 42 U.S.C 256b
Ambulatory Surgical Center
Therapist
Any other category of health care facility, entity, practitioner, or clinician determined appropriate by the HHS Secretary
Health IT Developer - An individual or entity, other than a health care provider that self-develops health IT for its own use, that develops or offers health information technology to EHRs and other Health IT software applications.
Health Information Networks (HIN) or Health Information Exchanges (HIE) – An individual or entity that coordinates access, exchange, or use of Electronic Health Information (EHI), primarily between or among a particular class of individuals or entities or for a limited set of purposes.
What Health Information is Covered under the Information Blocking Rule?
The rule will apply to all Electronic Protected Health Information (ePHI) as defined by HIPAA. This will include most materials in healthcare providers’ charts regarding a patient. Some of the types of medical records subject to the rule (and must be fully accessible) are:
Consultation notes
Discharge summary notes
Procedures notes
Progress notes
Imaging report narratives
Lab report narratives
Pathology report narratives
History and Physical (H&P) examinations
Billing Records
What do Information Blocking Terms Access, Exchange or Use Mean?
“Access” means the ability or means necessary to make electronic health information available for use, including the ability to securely and efficiently locate and retrieve information from any and all source systems in which the information may be recorded or maintained.
“Exchange” means the ability for EHI to be transmitted securely and efficiently between and among different technologies, systems, platforms, or networks in a manner that allows the information to be accessed and used.
“Use” means the ability of health IT or a user of health IT to access relevant EHI; to comprehend the structure, content, and meaning of the information; and to read, write, modify, manipulate, or apply the information to accomplish the desired outcome or to achieve the desired purpose.
Q: Is a healthcare provider required to fulfill a request for access, exchange, or use of EHI with all the EHI they have for a patient or should the amount of EHI be based on the details of the request? In addition, what if a provider only maintains some of the requested information electronically?
A: the fulfilment of a request for access, exchange or use of EHI, including what EHI is shared, should be based on the request. However, any activity by the provider that seeks to artificially restrict or otherwise influence the scope of EHI that is requested, may constitute interference and could be subject to the information blocking regulations.
Click here for additional ONC Cures Act Information Blocking FAQs
Avoid Information Blocking and get a better understanding of the 21st Century Cures Act by watching the video below
Information Blocking Claims: By the Numbers
ONC has greatly simplified the process of submitting an Information Blocking Claim. Information blocking claims can be submitted online through ONC’s Report Information Blocking Portal. The HHS OIG has the authority to investigate claims of possible information blocking across all types of actors: health care providers, health information networks and health information exchanges, and health IT developers of certified health IT.
The Information Blocking claims and information received by ONC in connection with a claim or suggestion of possible information blocking are generally protected from disclosure as specified by the Cures Act. Claims can be submitted anonymously as well.
ONC is tracking Information Blocking Claims starting from April 5, 2021 and now publishing the results monthly. There has been about a 20% increase in the number of validated Claims submitted from the end of 2021 to August 31, 2022.
About a 20% increase in the number of claims has been recorded from the end of 2021 to August 31, 2022.
The number of patients submitting Information Blocking Claims increased by 20% from the end of 2021 to August of 2022.
More than 75% of the Information Blocking Claims are filed on providers.
The number of Claims against providers went up about 35% from the end of 2021 to August of 2022.
Announce of Penalties for Healthcare Providers by HHS Overdue
Patients and providers have cited suspected Information Blocking by hospitals, healthcare facilities, physicians, and other providers. As evident from the ONC’s current data, over 75% of the Information Blocking claims filed in the past year are against providers reportedly blocking the proper flow of information. Specific penalties for healthcare providers are expected to be announced soon.
In April 2022 ONC Annual Meeting, HHS Secretary Xavier Becerra announced the plans to enforce the Cures Act against healthcare providers that improperly block information are a “top priority.” HHS was anticipated to announce a specific enforcement regiment of civil monetary penalties by the end of 2022. It is being considered again in a new proposed rule making (NPRM) proposal.
The Centers for Medicare and Medicaid Services (CMS), the largest payer and regulator of medical practices, has also announced its interest in levying civil monetary penalties for providers that improperly block the sharing of electronic health information.
The ONC is Transitioning from Incentives to Penalties
Micky Tripathi, ONC’s National Coordinator for Health Information Technology, mentions several key takeaways of the Cures Act in a recent interview. One of these is the transition of ONC’s approach from incentives to penalties.
• In December 2022, connectivity between electronic health records will get simplified from each EHR's API to a FHIR interface in standardized data elements.
• USCDI standardization will also accelerate consumers' ability to download their records into personal health apps they control.
• While the HHS OIG prepares to enforce the penalty phase of rule, ONC is prepared to wield the power of EHR decertification.
• Providers should "think strategically" about changing their EHR culture to one of authorized information sharing.
Source: HealthLeaders Media
WHAT IS FHIR® ?
Last year, the U.S. Centers for Medicare and Medicaid Services finalized a requirement for the use of Fast Healthcare Interoperability Resources (FHIR®) among many CMS-regulated payers and providers by July 1, 2021. Put simply, if your company serves patients on Medicare or Medicaid, you need a plan to adopt FHIR’s interoperability standard across your organization.
FHIR®: What’s in it for Providers?
As the promise of interoperability through FHIR® is beginning to materialize, many providers are stuck wondering “What’s in it for me?” Provider organizations of all sizes stand to benefit greatly from both a clinical and business perspective in the form of efficient clinical workflows, better patient outcomes and regulatory compliance.
Read More About the Cures Act and (g)(10) FHIR API
Why Patient Portals Alone Won't be Sufficient?
By January 1, 2023, Healthcare Providers will need to ensure that their EHR enables the FHIR® API functionality so that they can share Electronic Health Information (EHI) with their patients to Access, Exchange and Use data, via a third-party app of their choice, in the FHIR® format. Having a patient portal will not be enough.
The MeldRx Ecosystem enables a bi-directional flow of data for providers to share EHI securely with their patients, other providers, payers, HIEs, and Registries, and not just get Cures Act ready, but go beyond it.
MeldRx Provider Portal: Send invites to patients via a provider app
MyMeldRx: Enable Patients to view, manage, and share their data via a patient interface
How MeldRx Helps You?
Avoid Information Blocking by sharing patient's data with them in a secure way
Achieve MIPS compliance
Get Real-Time Access to provider-verified data
Simplify Care-Coordination with the ability to exchange patient data with other providers for collaborated care delivery
Reap benefits of bi-directional data exchange with Health Information Exchanges (HIEs)
Access SMART® on FHIR® apps for communication with Public Health Agencies
Leverage SMART® apps to track patients’ progress
Join the Others Who Have Utilized the Power of MeldRx
