CMS, ONC propose new interoperability rules

HHS is addressing one of the biggest issues in healthcare: interoperability. The agency, through CMS and the Office of the National Coordinator for Health Information Technology (ONC), has proposed new rules to support electronic health record (EHR) interoperability.

CMS' rule aims to make patient data more useful and transferable through open, secure, standardized, and machine-readable formats, while limiting the administrative burdens on healthcare providers. Under the proposal, patients would have access to electronic health information (EHI) at no cost, requiring healthcare providers to give patients access to this information digitally through application programming interfaces (API).

“(Our proposal is) by 2020 all health plans doing business in Medicare, Medicaid and through the federal exchanges, be required to share claims and other health information with patients through an API, and allow patients to take that information with them when they change plans … allowing them to be true partners in their healthcare,” CMS Administrator Seema Verma said on Feb. 11 on a call with reporters.

The proposal could impact 125 million patients overall, according to Verma.

Some elements of the proposal follow up on the work that CMS has already undertaken to improve access to health records, including MyHealthEData and Blue Button 2.0, which was launched in 2018 and allows beneficiaries to access their information through apps “of their choosing.”

“(You) can’t charge the patient for the data,” Verma noted on the call. “It’s their data, and it belongs to them.”

One major provision of the rule would require Medicare-participating hospitals, psychiatric hospitals and critical access hospitals (CAHs) to notify other healthcare providers if a patient is admitted, discharged or transferred. The proposal, which is a revision to the Conditions of Participation for hospitals and CAHs, sets a basic health and safety standard for care transitions across settings.

Other provisions in the proposal include helping patients find in-network providers by requiring MA providers, state Medicaid and CHIP fee-for-service programs, Medicaid managed care plans and CHIP managed care entities to publish provider directory data. Furthermore, CMS will publish the information of providers that engage in information blocking. 

"Practices that unreasonably limit the availability, disclosure, and use of electronic health information undermine efforts to improve interoperability,” the agency stated. "Making this information publicly available may motivate clinicians, hospitals, and CAHs to refrain from information blocking."

CMS is also seeking feedback on the issue of interoperability through two requests for information (RFIs) on the major provisions of the proposed rule, and will accept comments until early April.

Likewise, ONC is looking for feedback on its proposed rule, which calls for healthcare providers to adopt standardized APIs, which will allow patients to securely access health information on their smartphones or other mobile devices. The ONC proposal also seeks to make accessing EHI free for individuals and includes provisions against information blocking. 

“We encourage everyone––patients, patient advocates, healthcare providers, health IT developers, health information networks, application innovators, and anyone else interested in the interoperability and transparency of health information––to share their comments on the proposed rule we posted today,” Don Rucker, MD, National Coordinator for Health IT, said in a statement.

CMS did not issue an estimated cost of an individual healthcare provider to comply with the new rule, if finalized, but noted the RFIs aim to receive feedback on how to reduce burdens on providers.

Find CMS' proposed rule here and ONC's proposed rule here