February 18, 2019

As anesthesia practitioners know, the smooth and seamless exchange of information among systems remains a significant issue in anesthesia as well as in healthcare as a whole. After years of discussion and hand-wringing about the sector’s lack of interoperability, is change finally on the horizon?

The Department of Health and Human Services has issued two proposed rules to enhance interoperability across the health system, facilitate healthcare data-sharing and increase patient access to their health information.  The proposals, both of which tackle the issue of information blocking, were announced last week at the Health Information Management Systems Society (HIMSS) 2019 meeting.

The Interoperability and Patient Access Proposed Rule, released by the Centers for Medicare and Medicaid Services (CMS), outlines strategies for making patient data more transferable in open, secure, standardized formats. 

“We ask that members of the healthcare system join forces to provide patients with safe, secure access to, and control over, their healthcare data, ” CMS Administrator Seema Verma said in a statement.

CMS proposes to require Medicare Advantage (MA) plans, Medicaid, the Children’s Health Insurance Program (CHIP) and Qualified Health Plans (QHPs) to implement, test and monitor standardized application programming interfaces (APIs) to give patients access to their claims and other health information through third-party applications and developers by 2020. The proposal would build on CMS’s Blue Button 2.0 API for Medicare fee-for-service beneficiaries, launched last year. The proposed rule calls for use of Fast Healthcare Interoperability Resources (FHIR) as the standard for API development.

Among other things, CMS also proposes to: 

• Require CMS program participants to ensure electronic data exchange to support care transitions as patients move between plan types. If finalized, the proposal would give an estimated 125 million Americans access to their health information across programs.
• Enable payers and providers in CMS programs to participate in trusted exchange networks that would support the secure and private flow of data nationwide.
• Revise the Conditions of Participation to require hospitals, psychiatric hospitals and critical access hospitals to send electronic notifications when a patient is admitted, discharged or transferred.

Also last week, the Office of the National Coordinator for Health Information Technology (ONC) released the 21st Century Cures Act:  Interoperability, Information Blocking and the ONC Health IT Certification Program proposed rule.

The rule would, among other things, define reasonable and necessary activities that do not constitute information blocking.  The ONC proposal “would support patients in accessing and sharing their electronic health information while giving them the tools to shop for and coordinate their own healthcare,” said Don Rucker, national coordinator for health IT, in a statement. Health information networks and health information exchanges that violate the rule could be penalized up to $1 million for lack of interoperability.

The proposed policy identifies seven exceptions in which providers and healthcare IT companies could withhold electronic health data:

• To prevent physical harm to a patient or another person
• To protect privacy, including several sub-exceptions listed by ONC
• To promote cybersecurity
• To recover costs incurred in sharing health data
• To decline a request for data sharing that is “infeasible”
• To license interoperability tools, provided the agreement is fair and reasonable
• To conduct maintenance or improvements to health IT

The ONC is also calling for the adoption of standardized APIs, specifically FHIR, to enable patients to access their health information using their smartphones. 

Both the CMS and ONC proposed rules “address both technical and healthcare industry factors that create barriers to the interoperability of health information and limit a patient’s ability to access essential health information,” according to an HHS statement. “Aligning these requirements for payers, healthcare providers, and health IT developers will help to drive an interoperable health IT infrastructure across systems, ensuring providers and patients have access to health data when and where it is needed.”

Anesthesia has its own set of problems related to interoperability. “What most facilities want is an enterprise-wide solution that can accommodate all medical specialties and services; the anesthesia record option is often little more than an afterthought,” observed Jody Locke, ABC vice president of anesthesia and pain management practice services, in an article in Communiqué. That lack of alignment between the facility’s and the anesthesia department’s goals often contributes to issues of interoperability as well.

We encourage anesthesia groups to review the proposed rules and submit their ideas. Comments are being accepted on both rules through early April 2019. In an alert, the ASA said that it is also reviewing the rules and their potential impact on anesthesiologists, and plans to submit comments. We will provide updates as new information becomes available.

We want to hear from you.  Do you have a topic you would like to see covered in an ABC eAlert?  Please send your suggestions to info@anesthesiallc.com.

With best wishes,

Tony Mira
President and CEO