What the Landmark Interoperability 2020 Rules from CMS and ONC Mean for You

5 minute read

On March 9, 2020, the U.S. Department of Health and Human Services published a press release titled, “HHS Finalizes Historic Rules to Provide Patients More Control of their Health Data.”

The new rules come from two of the department’s major regulators: The Office of the National Coordinator for Health Information Technology (ONC), and the Centers for Medicare & Medicaid Services (CMS). And although these rules cover different specifics, taken together they send a single message that affects every business in the healthcare industry: The hour is getting late to implement digital interoperability practices for your patient data.

J2 Global recently co-hosted a webinar featuring two industry thought leaders to discuss the vast implications of these new rules. Below is a brief overview of that discussion, and what it means for your organization.

What are the 2020 final rules for health data interoperability?

The ONC Final Rule

This is a set of guidelines designed to prevent “information blocking” practices by healthcare providers, health information exchanges, and developers of certified health IT apps and systems.

The CMS Interoperability and Patient Access Final Rule

Building on the foundation set by the ONC Final Rule, these guidelines establish proactive practices for healthcare providers to take—with the goals of driving interoperability across the spectrum of healthcare and increasing patients’ access to their own data.

What do these guidelines actually state?

There are several provisions in each of these new rules, so we’ll review a few of their major components—any of which could affect your organization.

Providers will be required to use FHIR data standard (specifically, Release 4) to transmit patient data over APIs.

The CMS and ONC together have identified the Fast Healthcare Interoperability Resources (FHIR) data-format standard for exchanging patients’ electronic health records over APIs.

The goal: The regulators determined this data standard will be the best way to ensure both the privacy and security of patient information and the most efficient exchange of this data across providers’ many proprietary systems, apps, and platforms.

The timeline: The implementation timeline for organizations to be ready with FHIR-based data for API data exchange is January 1, 2021. But at least one industry group has asked for 1 year of additional time to get ready, so this deadline might be pushed out.

The implication: This rule could affect any provider across the patient’s continuum of care: payers, physicians, providers, vendors, health exchanges, etc. If a healthcare entity has not yet begun making its data accessible via APIs and has not begun exploring the FHIR data exchange standard, that entity needs to prioritize these steps soon.

Payers must allow patients to access their data digitally even years after coverage ends with that payer.

Under these regulations, CMS-regulated healthcare insurers are required to enable patients to access to their own data on the payers’ systems, up to five years after a patient’s coverage has ended.

The goal: Enable patient information portability, such that the insurance-related health information can more easily move with a patient from payer to payer and create a cumulative health record over time.

The timeline: The current implementation for this rule is January 1, 2022.

The implications: This rule will affect how all payers organize, archive, and allow access to their patients’ insurance-related data. One example: payers will be required to exchange US Core Data for Interoperability (USCDI) at the patient’s request, so they can transfer that data to their new insurer.

Information blocking by providers will result in penalties.

With these new rules, the ONC and CMS also take an enforcement approach and underscore that “information blocking” — disallowing other participating providers, payers, or patients to access health records — is illegal and violators will face punishment.

CMS will publicly report eligible clinicians, hospitals, and critical access hospitals (CAHs) that may be information blocking based on how they attested to certain Promoting Interoperability Program requirements.

The goal: The primary goal of these measures is to further facilitate patient data exchange across the healthcare industry. The agencies believe that publicly outing information-blocking providers will give patients an important data point in determining their own care.

The benefit of sharing Admission, Discharge and Transfer information is to enhance the continuity of care for the entire care team.

The timeline: As of September 2020, all health providers found to be engaging in information-blocking practices will face these new penalties. Deadline for electronic notification of ADT information is Spring 2021.

The implication: This rule places pressure on healthcare entities share data during transitions of care and to be more transparent with their health data (while still adhering to patient privacy and applicable laws, of course). If a provider develops a reputation for preventing other healthcare entities from accessing patient health records — and their organization is placed on federal regulators’ “hall of shame” list — this could negatively impact their business, as patients decide not to entrust their care to that provider.

What this means to your organization?

All of these individual provisions, across both the CMS and ONC final rules, have one thing in common: They all indicate that federal regulators are winding down their decade-long plan to “encourage” digital interoperability, and transitioning into the “enforcement” phase.

This means your organization needs to prioritize taking proactive steps to make your healthcare records accessible by other participants across the healthcare spectrum. That will include moving to a certified EHR, if you haven’t already done so, making sure you’re using tools that use the FHIR Release 4 data standard for APIs, and making your healthcare data readily accessible to legitimate information requests from payers, providers, and patients.

As a part of the information blocking regulations, CMS is specifically requiring that all hospitals provide Admissions, Discharge and Transfer (ADT) information to care team members. This intent is to ensure the best quality of care during transitions from different care settings. Consensus can help providers meet this requirement–even if they do not have an EHR or a certified EHR but want to share data electronically. Check out Consensus.

Learn more about what these new interoperability rules mean for you,
Watch the webinar: The ONC and CMS Final Rules’ Impact on Your Business.