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The post-acute perspective: CMS and ONC interoperability final rules

The latest update to healthcare IT regulations covers two large rule-making processes completed and finalized in March 2020, by both CMS and the Office of the National Coordinator for Healthcare Technology (ONC). The interoperability final rules include over a thousand pages of regulatory change. And while not all of it is immediately relevant to post-acute providers, certain parts deserve attention for both post-acute providers and the EHRs that support them.

Many providers are seeing this update as an administrative burden, but we see it as an advantage and opportunity for post-acute providers to get more data, make data-sharing easier, and elevate your coordination of care.

The biggest takeaway from this final rule is information blocking. Here, we’ll discuss what it is and how to see it as an opportunity to provide better care.

What is information blocking?

At its core, information blocking is an enforcement mechanism for something that either should have been in place or technically is in place, depending on how you interpret the interoperability final rules, and that is the appropriate and timely exchange of healthcare information from provider to provider and provider to their patients. Until now, there have not been clear rules or penalties for refusing to share health data. But with this final rule, you are obligated to provide this data to anyone with an accepted purpose of use—which are transition, treatment, and patient access.

Transition

When a patient is being transitioned, the referral process should include information about the patient so a post-acute provider can determine whether they can take the patient based on services needed.

Treatment

When treating a patient as a home health provider, you need access to the last PCP visit or hospital admission to properly create a care plan and profile their conditions.

Patient access

If a patient wants access to their data from you as a healthcare provider, you are obligated to give them that access.

An opportunity for post-acute care

If you’re thinking this update sounds like a positive expansion of healthcare technology, we agree. However, there are many organizations voicing concern about adding administrative burden to daily operations. Others are calling for more technical definitions around the health IT landscape, as there’s a lack of specific detail on regulation for EHR vendors (non-certified EHR vendors are not counted as actors). But those with concerns around the final rule are missing the forest for the trees: the new rules pave the way for expansive opportunities to improve care coordination, efficiency, and transparency through data access.  

If you’ve ever encountered a refusal of patient information from a referring provider, that will no longer be allowed. Why? Because no one wants the marketing nightmare of being federally registered as an information blocker.

Expect more avenues for data exchange

Since no organization or EHR wants to be labeled as an information blocker, more avenues will start opening for data exchange. If your EHR is connected to a nationwide network like CommonWell or Carequality, those tools will start pulling in even more data as providers start loosening up their sharing processes to conform to these new rules. This, along with EHRs being mandated to produce data points for the U.S. Core Dataset for Interoperability, ensures every single EHR has some ability to extract information. Providers should see two major opportunities:

  1. If you already have connectivity between health systems, expect it to become stronger, richer, and for more data to become available.
  2. Every single provider you work with uses technology, and that technology can be expanded upon and built with your EHR or IT team.

Hidden benefits of opening up data access

Information blocking rules do not mandate that you have to purchase a patient portal. All the rules are saying is that if a patient or provider requests data, you have to comply. It doesn’t have to be in a certain format. And if you get a data request that your technology is unable to support, there are exceptions included in the final rule that you can apply for.

Another smaller component of the interoperability final rules is around notifications. Hospital providers are now obligated to make a reasonable effort to notify post-acute providers that might be seeing the same patient at the same time that they admit. Your EHR should help with that “reasonable effort” with localized networks of providers or HIE integration.

Improved data sharing is a net win

In conclusion, these changes are a net win. They will improve the patient and clinician experience, and more data flowing will support continuity, transition, and coordination of care. Our advice to post-acute organizations is to invest in new workflows and spend time with your EHR to be ready to take full advantage of these changes.

Learn more. 


Chris Pugliese
Chris Pugliese

Chris Pugliese is a Senior Product Manager of Integration and Interoperability for MatrixCare. Chris has spent the last decade working with post-acute technology and EMRs, and the last 5 years focused on interoperability. His strength is enabling technology, as well as educating on the growing importance of interoperability and its benefits to the post-acute care settings. In a short time, Chris has become a leader, spearheading integration and interoperability initiatives within and outside of MatrixCare. Recent industry committee roles and responsibilities include: Leadership Team Member for the Post Acute Interoperability Work Group (PACIO), Technical Lead for the Functional Status Subgroup for the PACIO initiative – developing FHIR Profiles for Functional Status, CommonWell Health Alliance Use Case Committee member, CommonWell Health Alliance Specification Workgroup member


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