The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator of Health Information Technologies (ONC) on February 11 deployed additional rules proposed to improve the interoperability of health information systems, increase patient access to their electronic health information and prevent information blocking.

For doctors, the proposed rules have several important ramifications.

To begin with, health care providers who block information will be subject to civil penalties or "appropriate disincentives", although proposed NCB rule did not specify what they will be. Hospitals or physicians who acknowledge that they have interfered with the exchange of information with patients or with each other will be publicly identified. the ONC Rule also lists seven exceptions to information blocking in areas such as privacy, security, and harm to patients.

Starting in 2020, hospitals will be required to electronically notify physicians and other providers when their patients are admitted, discharged or transferred. "In order to participate in Medicare, we require all hospitals to send electronic notifications to designated health care providers when patients are admitted, discharged or transferred from the hospital, in order to improve the transition of care. between medical circles, to improve patient safety, coordination and general care, "said Seema Verma, administrator of the CMS, at a press conference.

The government has formally approved the Fast Health Interoperability Resources (FHIR) standard for clinical data exchange, which will be required in certified electronic health records. FHIR-based application programming interfaces (APIs), which can be used to link EHR data to patient-selected applications, will also be required.

In order to obtain certification for their products, EHR designers will also have to program the possibility of exporting electronically all the health information they "electronically produce and manage". This means that patients will have access to their complete electronic records and that physicians will be able to automatically export their current EHR data when they change their system.

To create clinical summaries, the certified EHRs will use the new US Basic Interoperability Data (USCDI) in place of the set of common clinical data. The USCDI extends the types of data available for interoperability. New categories of data include different types of clinical notes, pediatric vital signs, patient contact information, and information on the source of clinical data.

ONC has developed 10 recommendations for voluntary certification of health informatics for pediatric care. Among these are the inclusion of growth charts, calculation based on the weight of drug doses, verification of the unique dose range specific to age and weight, and the possibility of documenting all guardians and caregivers.

Increased options for patients

the Rule proposed by CMS will make it easier for patients to access claims data and provide them with a mechanism to interpret and use this data.

In 2018, CMS launched its Blue Button 2.0 API for traditional Medicare beneficiaries. The goal of this program is to enable patients to electronically access their claims data through a variety of applications. More than 1,500 application developers are creating tools designed to work with this API, Verma said. Seven applications are already available.

Under the proposed rule, private insurers who administer Medicare Advantage plans, Medicaid plans, child health plans and federal insurance plans will all need to develop APIs based on the CFSP for their members.

Nearly 40 million Medicare beneficiaries will potentially be able to access their claim data via the Blue Button 2.0 API, Verma said. By 2020, she added, all Medicare plans doing business with the government will need to have similar APIs. At this point, about 125 million patients will have access to the claims data, she said. She predicted that when so many members of private insurers will have this option, the plans will likely expand all of their members.

Verma anticipates that many patients will carry this information with them when they move from one health care provider to another. In addition, she said, FHIR-based APIs will allow patients to aggregate their clinical summaries from multiple patient portals instead of having to download a summary from each provider's portal. . The applications they use will help them understand the data and allow them to share it with the next visited provider.

According to the rule proposed by ONC, said Donald Rucker, MD, national coordinator for health informatics, health care providers and EHR providers will not be allowed to charge consumers the use of their data in third-party applications. "It's part of the payment for care," he said.

However, an application developer can charge its services to consumers. In addition, health care providers may charge fees to third-party developers whose apps consume their EHR data. The fees must be based on the costs incurred by the provider to provide access to, exchange or use the data.

The deadline for comments on the rules proposed by CMS and ONC is the beginning of April.

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