Federal Government Proposes Regulations to Improve Health Information Technology and Exchange Efforts

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ACP stresses the need for practical interoperability that promotes the sharing of actionable, context-rich data at the point of care.

March 8, 2019 (ACP) – “Interoperability” might be a chunky word, but it's a vital concept in American medicine: Health systems must be able to efficiently transfer information about patients without unduly burdening physicians or office staff.

Now, the federal government is airing new regulations about moving forward on this front, and the American College of Physicians is poring over more than 700 pages of proposed policies and preparing an official response.

ACP is pleased by some of the recommendations, which come from the Office of the National Coordinator for Health Information Technology (ONC), charged with coordinating national efforts regarding advanced health information technology (IT). But, the College also has concerns and hopes the ONC will make adjustments.

“We remain concerned about the federal government's overall focus on interoperability, which is one that focuses on enhancing the flow of all data and moving large clumps of data elements back and forth,” said Brooke Rockwern, an ACP associate for health IT policy.

“Clinicians DO NOT need access to every piece of health information ever collected,” she said. “They need actionable and context-rich data at the point of care.”

Among other things, the newly proposed policies set rules regarding “information blocking” – interfering with the exchange of electronic health information. ONC identified those actors who are subject to the information blocking regulations – including physicians – and outlined seven exceptions to information blocking.

“We will focus a lot of our review and analysis on how these information blocking regulations will affect physician practice and highlight any concerns with the proposals,” Rockwern said.

They also require that patients be able to access their electronic health information at no cost, and they call for the adoption of technology that will allow patients to access certain kinds of health information using their smartphones.

“The College is encouraged by the proposals, which promote the use of specific standards,” Rockwern said. “A lot of ACP's previous advocacy around promoting interoperability and reducing burden has called on the industry to accept and implement the same health IT standards in order for systems to be able to better communicate.”

Even though ONC is not creating a “new” edition of certified electronic health record technology (CEHRT), they propose a number of changes to the existing 2015 edition that will require upgrades to existing EHR systems, and it is unclear how physicians will determine what version of their EHR meets regulatory requirements. ACP intends to address these concerns and reiterate concerns that patient care would suffer if physician practices were forced to move too quickly to implement upgraded technology in order to meet regulatory requirements, including participation in the CMS Quality Payment Program.

“There are some downstream effects on physician practice that can occur when systems are upgraded and practices or health systems are not given enough time to properly implement and deploy those upgrades – including the sheer amount of time it takes to effectively deploy new technology, staff training and workflow adjustments – that create potential risk to patient health,” Rockwern said.

Comments regarding ONC's proposed policies are due May 3, and “ONC then has to review and address all of the public comments they receive prior to finalizing the rule,” Rockwern said. “The publication of the final rule will depend on the review process and whether they come across any major issues with the proposed policies.”

Once ONC issues the final policies, she said, it plans to give electronic health record vendors two years to make mandated changes to their systems.

“Collaboration across the federal government, private payers, health IT vendors, as well as clinician and patient organizations is critical in order to tackle the complex issues surrounding interoperability,” Rockwern said. “We will continue to voice our concerns and articulate ways to advance practical interoperability.”

More Information

A copy of the proposed rule, and more information about the process, can be found on the website of the ONC, part of the Department of Health and Human Services.

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