The way healthcare communication works right now is very straightforward: Patients receive care. Providers provide care. Payers pay for care per the terms of the policy.
It’s a very linear process. However, traditionally in healthcare, we haven't always done a great job of seamlessly connecting these things.
If we're going to improve care coordination, reduce cost, and improve patient outcomes, the key comes down to one thing: more interoperability! In other words, the increased ability of computer systems or software to exchange and make use of information.
Enter the 21st Century Cures Act.
Signed into law on December 13, 2016, the Cures Act was designed to help accelerate medical product development and bring new innovations to patients who need them faster and more efficiently. And now in 2021, the Cures Act will make great strides in becoming the mechanism that necessitates interoperability among patients, providers, and payers.
In a recent webinar, iShare Medical founder and CEO, Linda Van Horn, discussed the new Cures Act rules that will affect our industry beginning next spring, and answered some of your most pressing questions about what it means and what we should be doing to prepare.
It’s Time to Change the Way We Store Medical Records
Today, even with all of our electronic health records (EHRs), the way we store data leaves much to be desired. Most medical records are stored in silos, incomplete, and not easily shared. This leads to:
- Increased medical errors
- Inefficient workflows
- High cost
The COVID-19 pandemic highlighted the U.S. Health Systems’ inability to effectively exchange and use data and emphasized the need to accelerate nationwide interoperability.
The Cures Act is poised to change all of that.-
The 3 Final Rules from Health and Human Services
- When passed by Congress, the Cures Act mandated the Office of the National Coordinator for Health Information Technology (ONC) and Centers for Medicare & Medicaid Services (CMS) to create new rules around interoperability that will change the way we communicate.
Essentially, Congress told both agencies (ONC and CMS) what the Cures Act needed to achieve. They provided a basic framework for the ONC and CMS to produce an implementation plan.
The subsequent implementation plan created by both health department agencies produced the following 3 rules.
Rule #1- Information Blocking Rule simply states that beginning April 5, 2021, providers and payers cannot block information. Applicable to healthcare providers, health information networks, and health IT developers, the goal of this rule is to be able to share complete information among patients, provider, and payers.
A hefty fine of up to $1 million per violation can be imposed on Health IT Developers, Health Information Networks, and Health Information Exchanges, but left the penalties on Health Care Providers to be defined at a later date.
There are 8 exceptions in 2 categories:
The Information Blocking Rule also defined what data had to be shared. Starting on April 5, 2021 and continuing through October 6, 2022, the Common Clinical Data Set will be replaced by the United States Cord Data for Interoperability (USCDI).
Rule #2- ONC Health IT Certification Rule defines the technical requirements that Health IT vendors must comply with in order to become a Certified Electronic Health Record Technology (CEHRT). In addition, Health IT Vendors must provide assurances they are not blocking the sharing of information.
Starting on April 5, 2021, Application Program Interfaces (APIs) must be made available to patients and Health IT Vendors can no longer prohibit the sharing of screenshots of their products. By the end of December 31, 2023 new API’s must be capable of exporting all electronic health information.
In other words, the healthcare industry must now adopt standardized APIs that allow individuals to easily access and exchange electronic health information.
Rule #3- CMS Interoperability and Patient Access Rule brings big changes that allow patients to get access to their data from CMS and other government payers and for Qualified Health Plans issuing policies in the Federally-Facilitated Exchanges.
This includes Medicare Beneficiaries and other government programs by leveraging CMS’ authority to regulate Medicare Advantage (MA), Medicaid, Children’s Health Insurance Program (CHIP), and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs)
CMS is also making some of these rules a Condition of Medicare Participation (COP). This means that providers must comply with these rules in order to participate (bill and get paid) by Medicare and other government payers.
Starting on July 1, 2021, the CMS Interoperability and Patient Access Rules require that patients be provided access via APIs to their data and to a provider directory that contains the electronic endpoint where they can request data. Further, these APIs are to comply with the Fast Healthcare Interoperability Resources (FHIR – pronounced “fire”) Standard at version 4.0.1.
CMS is requiring as a condition of participation in Medicare that hospitals send event notifications when patients are admitted, discharged, or transferred to or from the hospital. These are also known as ADT Messages.
CMS is also requiring that Qualified Health Plans exchange patient data from payer-to-payer beginning on January 1, 2022.
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What Do These Rules Mean for Patients, Providers, and Payers?
Chances are, at some point you’ve yearned for a framework where information could be used to create a learning health system.
A learning health system improves care coordination with things like: