Providers, associations hopeful new interoperability rules will achieve aims

HHS is pushing new interoperability rules to encourage better care coordination and empower patients to become stronger partners in their care through access to their digital health records––and the industry seems to be on board.

The rules, which were proposed through CMS and the Office of the National Coordinator for Health Information Technology (ONC) on Feb. 11, would force all health plans doing business with Medicare, Medicaid and the federal exchanges to give patients free access to their health records digitally and follow several new requirements that encourage interoperability across electronic health records (EHRs) and care settings.

The proposed rules bring about these requirements by 2020, though CMS has not released an estimate of the individual cost to providers to comply.

Interoperability challenge

At first glance, many industry groups and health systems appear to be on board with the proposed rules. Interoperability is a major issue in the healthcare industry, preventing providers across settings from conducting true care coordination and enabling patients to be engaged in their own care plan. The rules require providers to work on open standards-based application programming interfaces (APIs) so patients can view their digital health information in one place, as well as support the exchange of this data.

For Stan Huff, MD, chief medical informatics officer at Intermountain Healthcare, there is a need for shared clinical information models, though there are technical and standards issues of information sharing. These issues are compounded by legalities of trust, such as HIPPA compliance and other security, he told HealthExec. Intermountain Healthcare, based in Salt Lake City, Utah, is a not-for-profit health system with 23 hospitals, 170 clinics, health plans, and a medical group with nearly 2,300 physicians and advanced practice clinicians.

Above all, what is missing in the path toward interoperability is the “business case” for sharing data, according to Huff.

“Right now, fee-for-service payment models encourage people and organizations to keep data in their own systems,” Huff told HealthExec. “They can redo lab tests or imaging studies and they make money on those fee-for-service activities. Sharing data can provide information to your competitors about your patient population base, the quality of service that you provide. We need to have policies and procedures in place that provide monetary incentives for sharing data and improving the quality of healthcare outcomes.”

The proposed rules appear to make that business case by moving incentives for providers to engage in health information exchanges.

“I think the CMS rules are in the right direction,” Huff told HealthExec. “The most important thing that CMS can do is to make sure that payments are aligned with improved quality and reduced cost, that secure access to patient data is guaranteed, and require folks to implement standards.”

New standards

While the rules will give patients more access to their own data, healthcare providers and EHR vendors will have to meet the new standards outlined.

“The burden really falls to software developers and providers (such as EHR vendors) that provide systems for the individual providers,” Huff said, noting that most companies are already pursuing Fast Healthcare Interoperability Resources (FHIR) standards.

“Still, there will be development costs and those costs will be passed on to the end users. So, the new rules will cause work, but it is work that will benefit every aspect of healthcare and will improve the quality of care that we provide.”

EHR providers see opportunity in the rules, with the capabilities to engage patients already in place.

“We are excited that CMS has put the patient at the center in this new rule, something that EHR developers do every day,” the Electronic Health Record Association told HealthExec in a statement. “EHR Association members and other developers of certified EHRs already offer the type of APIs that CMS is now proposing for the payer space.”

Still, the association wants more time than the 90-day comment period to give feedback on the proposal, including the proposed timeline and potential provider burden.

Another component of the rule would end information blocking, through public reporting of healthcare organizations that withhold data or intentionally limit or restrict interoperability of health IT.

“By withholding a patient’s health information from competing healthcare providers, a healthcare provider can effectively inhibit a patient from freely moving within the healthcare market because that patient would not otherwise have access to their complete health information,” the proposed rule reads.

The rules include seven exceptions to the definition of information blocking. CMS also asked for feedback in this area from stakeholders, something the industry supports.

“At first glance, we are pleased that ONC’s information blocking rule acknowledges in its exceptions the importance of promoting the privacy and security of electronic health information, which is a core tenet of the HIM (Health Information Management) profession,” American Health Information Management Association (AHIMA) CEO Wylecia Wiggs Harris, PhD, CAE, said in a statement.

Stakeholders will have until early April to provide feedback to the agencies, with hopes that the outcome of the proposed rules will meet their targets.

“I hope that the biggest impact is the one that was intended—that interoperability will increase dramatically over the next few years,” Huff said.