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Getting Ready for New Federal Rules on Interoperability & Information Blocking

The Department of Health and Human Services (HHS) will soon publish final rules on several facets of the 21st Century Cures Act that have broad ramifications on the healthcare technology industry. Taken together, these efforts are aimed at facilitating interoperability to improve care coordination and transitions of care.

Interoperability and Patient Access Proposed Rule

Among the soon to be published rules are changes to the Conditions of Participation (CoP) for the Medicaid and Medicare programs (Interoperability and Patient Access Proposed Rule). CoP are requirements that hospitals and other providers must meet in order to participate in the Medicare and Medicaid programs. Given the economic heft of Medicare and Medicaid, the Centers for Medicare and Medicaid Services (CMS) can mandate spread of HHS policy priorities through revisions to CoP, in this case as it relates to interoperability and care coordination.

On February 22, 2019, CMS published a proposed rule that would amend the CoP to require hospitals and critical access hospitals with electronic health records to send electronic notifications to designated providers when patients are admitted, discharged, or transferred (ADT) to healthcare facilities or providers. The comment period ended on June 3, 2019 and is expected to be finalized soon. The rule, if finalized as currently written, will require hospitals to identify and communicate with other providers.

How Collective Can Help

At Collective, we believe that effective care coordination and seamless transitions of care are an essential component of a well-functioning health care delivery system. This belief undergirds everything we do. ADT information is a valuable data element for providers across the care continuum and should be shared to optimize patient care. Collective enables hospitals and providers to seamlessly share ADT data. Yet, to sufficiently improve care and facilitate coordination, we complement this necessary ADT information with other clinical data and meaningful analytics to give providers the full picture of information they need to make decisions at the point of care.

Collective provides the nation’s leading network for care collaboration. With our network of more than 1,000 hospitals and every major health plan across the country, we have the functionality that can enable hospitals to comply with both the letter and spirit of this rule. We are committed to working directly with hospitals, health information exchanges, and other entities to ensure that providers meet the requirements and receive the benefits of ADT data sharing.

Learn more about Collective’s ADT-Enabled Collaboration Network.

Information Blocking Proposed Rule

The other significant policy forthcoming from HHS is the final rule on information blocking, another facet of the 21st Century Cures Act. The final rule, which is expected to be published in January 2020, will put guardrails on what constitutes information blocking while also giving HHS enforcement abilities. The following are examples of information blocking in the proposed rule:

  • Imposing formal or informal restrictions on access, exchange, or use of electronic health information (EHI)
  •  Implementing capabilities in ways that limit the timeliness of access, exchange, or use of EHI
  • Imposing terms or conditions on the use of interoperability elements that discourage their use
  • Discouraging efforts to develop or use interoperable technologies or services by exercising influence over customers, users, or other persons
  • Discriminatory practices that frustrate or discourage efforts to enable interoperability.
  • Rent-seeking and opportunistic pricing practices

There are seven proposed exceptions to the rule, including (but not limited to) information that is required by applicable law and identified as necessary to protect patient safety, to maintain the privacy or security of individuals’ health information, or to promote competition and consumer welfare.

The full ramifications of the information blocking rule will unfold over time with predictions in some quarters of significant legal challenges between vendors. We at Collective believe that the implementation and enforcement of information blocking rules will help to move the industry away from commoditizing data toward a bigger and more meaningful vision, in which the health IT industry builds functionality and capability that builds on free flowing data in order to create actionable insights that can impact the lives of patients. It is our hope that HHS uses its enforcement authority wisely in order to spur innovation, rather than quash it.

Vatsala Pathy
VP, Regulatory and Government Affairs