CMS and ONC Propose New Rules for Interoperability

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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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Protecting Patient Safety through Health IT and EHR Use

The Health IT Safety Center Roadmap, recently released from the Office of the National Coordinator (ONC), presented a plan for taking important steps toward improving the safety of Health IT and, therefore, patient safety. Its purpose, clearly stated, is because “Today, thousands of health care professionals, hospitals, and their patients enjoy quality and safety improvements from electronic ordering, decision support, results reviewing, and other EHR functions”. Electronic Health Record EHR software has dramatically improved patient safety e.g. by improved legibility of writing (no more trying to figure out doctor prescriptions and dosage), communication flow within clinic (no more hunting/looking for paper charts) and automatic drug-to-drug and drug-drug alerts etc. “At the same time, safety organizations and researchers, health IT users, and other stakeholders have found risks and hazards to patient safety associated with these systems and the complex environments in which they are implemented and used.”

In a recent blog posted on the ONC’s website, Andrew Gettinger, M.D., Chief Medical Information Officer, Acting Director, Office of Clinical Quality and Safety emphasized that “doctors, nurses, and other clinicians that are all part of the care team are frustrated by health IT systems that are not coordinated or optimized to their workflow. Many of these systems will benefit from better usability and feedback from user community”

The complexities woven into this statement incorporate the facts that EHR use and the resulting new workflow processes can be very new and disruptive, many healthcare providers are not tech savvy and most EHRs are cumbersome and tedious to use. Thus, it is important to have an EHR which is easy to use and learn. For example, smartphones with app technology is easy to use and yet provides very complex functions. Similarly, newer EHRs use apps technology to build an EHR. These newer EHRs allow one to customize and personalize a user workflow by simply moving and rearranging apps or widgets on the screen. For example, if you are nurse, you can have only the widgets (family history, vitals, allergies, etc.) you need, in the order you do your work. This is similar to rearranging and personalizing apps in your smart phone. Newer EHRs also allow you to make your screens clutter free by only having what you need on your screens. Thus EHRs using apps technology, by allowing personalization of your screens and making them clutter free, can further improve patient safety.

The ONC report states, “The safety of health IT can be improved, and the improvement should be continuous, as part of a learning health system.” Thus you wish to partner with an EHR vendor which provides ongoing learning and collaboration opportunities with other customers, for example, via user focus groups. User focus groups can provide advanced learning as well as improve processes based on peer-to-peer learning.

If you are still in the process of replacing an existing EHR or looking for a new EHR system, you need to find an EHR system which is a) easy-to-use and easy-to-learn by your staff and b) EHR vendor provides user focus groups for advanced learning as well as collecting feedback on how to improve the product further.

Like everything new, there are positives and negatives associated with EHRs. In the Roadmap, developed by RTI, International, Gettinger notes “Even clinicians who were completely frustrated with the electronic health records that they are currently using, if given the opportunity, few said they would return to paper and pen-based records.”

Learn how to implement Stage 2 Meaningful Use and EHR interoperability standards

Stage 2 Meaningful Use is a bit more involved than the Stage 1 requirements. There is a lot to know and getting it straight doesn’t happen overnight. But there’s help. The Office of the National Coordinator (ONC) has online training modules available to help educate Eligible Professional (EPs) and Critical Access Hospitals (CAHs) on how to implement new standards of the Stage 2 Meaningful Use (MU) rule.


These courses use real-world examples in story-telling format to highlight the interoperability of EHR standards. They are designed to better equip providers, hospitals and support staff in meeting new MU objectives. There are five different web-based modules that can be done on your own time.


  1. Interoperability Basics covers implementation of new standards in support of transition of care, Lab exchange, patient engagement and public health measures.
  2. Interoperability and Transitions of Care demonstrates how to apply interoperability standards for transition of care and medication reconciliation.
  3. Interoperability and Lab Exchange equips you with the tools needed to better understand Lab Exchange and practical solutions for challenges you may encounter.
  4. Interoperability and Patient and Family Engagement reviews the important differences between Stage 1 and 2 MU and the challenges and solutions to meeting the new objectives.
  5. Interoperability and Public Health provides an overview of steps providers must take to begin the onboarding process with their Public Health Agency to begin submitting data electronically.


Begin your first course now, or for more details you can read the Interoperability Training fact sheet. The ONC information is excellent but you may need additional help specific to your agency. Of course, a good Electronic Health Record software company will also provide you Incentive Assistance service.