Posted By Lorana Price On March 25, 2019

CMS and ONC Propose New Rules for Interoperability

Rules for Interoperability and Patient Access to Electronic Health Information

The U.S. Department of Health and Human Services (HHS) recently proposed new rules to support seamless and secure access, exchange, and use of electronic health information (EHI). The rules were issued by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC). The intention of the rules is to increase choice and competition, which will be realized by:

  • Improving secure patient access to their health information
  • Giving patients more control over their health information
  • Requiring that patient access to the EHI be free to patients

ONC’s Proposed Rule

Electronic Health Information and Patient Access

ONC’s rule promotes secure and (more) immediate access to health information. This applies to both patients and their providers. The rule calls for the adoption of standardized application programming interfaces (APIs). APIs will enable patients to access their data using their smartphones and other mobile devices.

Additionally, the rule implements the information blocking provisions outlined in the 21st Century Cures Act. This will support access and exchange of electronic health information . The rule included seven proposed exceptions to the definition of information blocking, as well.

ONC also proposes patients be able to access their EHI at no cost. This would help patients see the prices they are paying for their healthcare.

Finally, ONC’s proposed rule would modify the 2015 Edition health IT certification criteria and program to advance interoperability, enhance health IT certification, and reduce burden and costs.

CMS’s Proposed Rule

CMS’ proposed changes to the healthcare delivery system support the MyHealthEData initiative. The goal of the changes is to increase the flow of health information, reduce burden on patients and providers, and foster innovation. In 2018, CMS finalized regulations that use potential payment reductions for hospitals and clinicians to encourage providers to improve patient access to their electronic health information. 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 provide patients with immediate electronic access to medical claims and other EHI by 2020.

CMS would also require these health care providers and plans to implement open data sharing technologies to support transitions of care as patients move between these plan types. By ensuring patients have easy access to their information, and that information follows them on their healthcare journey, redundant procedures and testing will be eliminated. Thus, clinicians will have the time to focus on improving care coordination and, ultimately, health outcomes.

CMS Administrator Seema Verma said, “By requiring health insurers to share their information in an accessible format by 2020, 125 million patients will have access to their health claims information electronically. This unprecedented step toward a healthcare future where patients are able to obtain and share their health data, securely and privately, with just a few clicks, is just the beginning of a digital data revolution that truly empowers American patients.”

Combined, these proposed rules address technical and industry factors that create barriers to interoperability and limit a patient’s ability to access their health information. Aligning these requirements for payers, health care providers, and health IT developers will help drive an interoperable health IT infrastructure across systems. This ensures providers and patients have access to health data when and where it is needed.

Additional Resources:

Fact sheet on the CMS proposed rule (CMS-9115-P)

Fact sheets on the ONC proposed rule

To read all 724 pages of the HHS’s new rules


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About Lorana Price

Lorana Price is a Marketing Executive at Patagonia Health. Her background includes work with regulated document management software, home healthcare software and global medical device commercialization. She applies her skills at Patagonia Health by developing content related to important Public and Behavioral Health news and updates.