Groundbreaking Rules for Electronic Health Records Proposed

The U.S. Department of Health and Human Services is proposing new rules that could pave the way for increased exchange of healthcare data by 2020.

The rules, issued by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), would allow patients to have access to their electronic health records (EHR) at no charge. They also would be able to transfer them more easily from one provider to another. Instead of having patient information in disparate systems, the rules give all payers the ability to exchange data seamlessly and allow patients to obtain a complete picture of not only their own healthcare, but also their insurance claims information in one place. This would allow for better coordination of care.

The rules will apply to Medicare Advantage plans, Medicaid managed care plans, Children’s Health Insurance Program, and health insurers that are offering plans through the Affordable Care Act’s health insurance exchanges. However, it’s hoped that private insurers also will pick up the mantle.

Providers or hospitals that refuse to take part would be publicly reported in an effort to “motivate clinicians, hospitals, and CAHs to refrain from information blocking,†CMS noted in a fact sheet.

The rules build on CMS’ earlier efforts to create a more interoperable healthcare system designed to improve patient access, while also enhancing coordination of care.

Specifically, the proposed rule calls on the healthcare industry to adopt standardized application programming interfaces (APIs), which will help allow individuals to securely and easily access structured and unstructured EHI formats using smartphones and other mobile devices. It also implements the information blocking provisions of the 21st Century Cures Act, including identifying reasonable and necessary activities that do not constitute information blocking.

The data made available would include information about diagnoses, procedures, tests and providers seen and provides insights into a beneficiary’s health and healthcare utilization. It’s believed the sharing of such information will reduce paperwork, eliminate redundant procedures and free up provider time.

CMS also is proposing requiring psychiatric hospitals, critical access hospitals and facilities that participate in Medicare to send “electronic notifications when a patient is admitted, discharged or transferred,” according to a summary of the rule.

CMS will accept comments on the major provisions in this proposed rule, as well as RFIs with clear and concise proposals that include data and specific examples until early April.

The Health Law Offices of Anthony C. Vitale can assist clients in understanding how the proposed rules would affect their EMR/provider model. If you have any questions, contact us at 305-358-4500 or send us an email to info@vitalehealthlaw.com.