Why CMS is pushing for interoperability

CMS, in conjunction with the Office of the National Coordinator for Health Information Technology (ONC), recently proposed new rules to regulate interoperability standards. The rules would impact healthcare providers and plans, and ultimately give patients better access to all their health information––for free.

That patient-centric goal is driving the new rules, which were released on Feb. 11, CMS officials said during an open forum call Feb. 26. Specifically, the regulations could help patients become more active participants in their care by having more information about their health information digitally and have the ability to move their data across providers.

Under the Health Insurance Portability and Accountability Act (HIPAA), patients are supposed to have greater access to their own health records and data, but under the current system, “that’s not actually happening,” CMS officials stated. Information blocking, where providers, health IT vendors or electronic health record (EHR) vendors knowingly and unreasonably interfere with the exchange and use of electronic health information, is currently a problem in the healthcare space that CMS aims to address with the rules.

“We know the data is not flowing,” they said.

The rule is set to be released on the Federal Register March 4, with a 60-day comment period.

Proposed provisions

The rule from CMS contains five proposals for health plans and providers, marking the first time the agency has regulated interoperability requirements for health plans, CMS officials pointed out. The provisions would impact all health plans and payers regulated by CMS.

The five proposals include:

  1. Patient access to digital health records through application programming interfaces (APIs)
  2. Require health plans and payers to make a public provider directory available through APIs
  3. A payer-to-payer exchange that allows patients to request their information from a prior health plan to be sent and incorporated into the records of their new health plan
  4. A requirement of providers and payers to join trust networks that facilitate the flow of information
  5. A requirement of daily communication from states with CMS about dual eligible patients enrolled in both Medicare and Medicaid

For providers specifically, there are three additional proposals from ONC:

  1. Public reporting of clinicians and hospitals that engage in information blocking, based on a self-attestation survey
  2. Report the names of providers that do not update the provider directory
  3. A new condition of participation for hospitals that requires them to send notification upon admission, discharge or transfer of a patient to a provider with an established care relationship with that patient

Industry associations appear to be on board with the objectives in the proposals, and CMS has included three requests for information (RFIs) in the proposed rule seeking feedback from stakeholders.

Specifically, CMS is looking for feedback for a proposal to include interoperability regulations in all future models from the Center for Medicare & Medicaid Innovation (CMMI). These regulations would vary across types of providers and be based on what the future models look like. The second RFI relates to patient matching, as CMS wants to address this barrier of confidently matching patients to their records when sending or receiving health information. Lastly, the agency seeks comment from the public on how to better incorporate post-acute care providers into the health IT and interoperability space.

Above all, the impacts of the proposals are intended to increase access to health information of patients, CMS officials stressed.

“This information does belong to the patient,” they said.

Providers can expect more interoperability and health IT regulations and a focus from CMS on this area in the future.