The proposed changes have drawn support from one prominent hospital advocacy organization.


Feb. 13—A requirement that hospitals share specific information electronically at discharge in order to participate in Medicare was one of several hospital-focused provisions in a new federal data-sharing push.

The U.S. Department of Health and Human Services (HHS) this week proposed two new rules to improve patients’ access to their electronic health information.

One of the proposed rules, from the Centers for Medicare & Medicaid Services (CMS), would revise Medicare’s and Medicaid’s conditions of participation for hospitals and critical access hospitals to require “electronic notifications” to other providers caring for their patients.

The requirement would apply to hospitals with electronic health record (EHR) systems capable of generating electronic patient-event notifications—“virtually all EHR systems,” according to CMS. It would require sending the notices at admission, discharge, or transfer to other providers identified by the patient.

“This is a small step in improving the discharge process for patients and their care teams, but it’s a significant first phase of the policies we are proposing,” Seema Verma, administrator of CMS, said this week at an industry meeting.

The notifications can range from simply sharing the patient’s name, basic demographic information, and the sending institution to encompassing a richer set of clinical data.

“However, regardless of the information included these alerts can help ensure that a receiving provider is aware that the patient has received care elsewhere,” the rule stated. “By providing timely notifications, the alert may improve post-discharge transitions and reduce the likelihood of complications resulting from inadequate follow-up care.”

CMS expected the proposal to impose “minimal additional costs” on hospitals. Specifically, it will cost an estimated $160 million for hospitals without the EHR capability to hire a consultant to perform the task. However, CMS also estimated that hospitals and clinicians would obtain a total annual net benefit of up to $3.8 billion from the two newly released rules, according to the proposed rule defining “reasonable and necessary activities” that do not constitute information blocking per the Office of the National Coordinator for Health Information Technology (ONC).

The new requirements were justified in part by the $35 billion the federal government has spent under the EHR Incentive Programs, which both funded EHR adoption and penalized hospitals that did not implement such systems.

“(H)owever, despite the fact that 78 percent of physicians and 96 percent of hospitals now use a certified EHR system, progress on system-wide data sharing has been limited,” the rule stated.

Addressing Information Blocking

The ONC rule also would bar healthcare providers from “inappropriately restricting the flow of information to other healthcare providers and payers.”

“Information blocking is a significant threat to interoperability and can limit the ability for providers to coordinate care and treat a patient based on the most comprehensive information available,” the rule stated.

The rule would “publicly report” the names of clinicians and hospitals that submit a “no” response to certain attestation statements related to the prevention of information blocking. The goal is to deter healthcare providers from “engaging in conduct that could be considered information blocking.”

Existing CMS rules require providers to attest to three statements related to information blocking. To be deemed a meaningful EHR user under the Promoting Interoperability Program, hospitals must attest “yes” for each of the statements.

Any hospital giving a “no” response will be listed on the CMS website beginning in “late 2020.”

Such steps are necessary, the rule stated, because of the number of hospitals and health systems that routinely prevent information sharing—a quarter of all such organizations, according to a survey. Motivations include strengthening competitive position relative to other hospitals and health systems, according to the survey.

Other hospitals are impacted by information blocking. In 2015, almost half of hospitals (46 percent) nationwide reported having difficulty exchanging data with providers whose health IT system differed from theirs, and one-quarter reported paying additional costs to exchange electronic health information with providers outside their hospital system, according to federal data.

The new rule also identified the FHIR standard as the approach CMS will use to implement its policies, including promotion of scalable data sharing versus merely sharing individual patient records between providers.

“We encourage the industry to align in this direction, because it is coming. Locking information into proprietary data models will soon be a thing of the past,” Verma said.

CMS estimated the rules would impact 439,187 healthcare providers in 95,470 clinical practices and 4,519 hospitals.

The proposed policy changes were generally praised by hospital advocates.

“We appreciate ONC’s proposed enhancements to the conditions and maintenance of certification and the proposed requirement that AP Technology Suppliers publish the terms and conditions applicable to their API [application programming interface] technology,” Blair Childs, senior vice president of public affairs for Premier, said in a written statement.

The proposed rule also will require Medicare Advantage plans, state Medicaid and CHIP programs, Medicaid managed care plans, and CHIP managed care organizations to make their provider networks available to enrollees and prospective enrollees through open-source technology. The requirements aim to ensure that up-to-date information from all providers is available for use by developers building web tools to support beneficiaries.

Potential Steps

Future steps under consideration but not included in the proposed rules include updating the Promoting Interoperability Program (formerly the Medicare and Medicaid EHR Incentive Programs) to “encourage” certain hospital interoperability actions.

Such activities could include maintaining an open API that provides consistent access to third parties, enabling patients to access their health information.

Such “interoperability activities” will be included in the FY20 Inpatient Prospective Payment System rulemaking, according to CMS staff.

CMS also requested comments on efforts that the agency is leading in the areas of patient identity and patient matching.

“This is a critical issue that has plagued data-sharing efforts for years, and we need to find a solution,” Verma said.

CMS also is looking for input on ways to ensure that post-acute care providers adopt healthcare technology to allow for a more seamless flow of data.


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare 

Publication Date: Thursday, February 14, 2019