Risk Adjustment

ONC, CMS Interoperability Rules: A Review

Recently, the Office of the National Coordinator for Health Information Technology (ONC) released a draft of their Strategic IT Health Proposal for 2020-2025. This proposal addresses the deliverables included in the 21st Century Cures Act, which focuses on making health data accessible to patients and care providers, increasing choice, encouraging competition, and fostering innovation.

 

Delivering Access

 

As healthcare moves from a fee for service payment model to value based care, the need for improved access and exchange of healthcare data between care providers, patients and health plans has become critical. Providers need access to the right patient data at the right time without it being burdensome. Patients need transparency to be empowered participants in their health. Health plans need to be able to support transitions in care as patients move between plans.

While the response from the industry on the proposed rules has been varied, it is expected that the new rules will be finalized within the next month. With the new rules comes a big push for interoperability, including standards which can be used nationally and methods to prevent information blocking.

 

Setting the Standard

 

Historically, although there have been interoperability “standards” in place, interpretations of those standards have varied greatly. With that in mind, the ONC is proposing the adoption of the United States Core Data for Interoperability standard (USCDI). With these new standards, the code formats and key data elements that need to be exchanged will be clear and consistent, and essential to promoting interoperability on a national level.

The USCDI v1 proposes the addition of two new fields, chart notes and provenance. Provenance will provide insight into where the data is sourced from. As USCDI matures, additional data elements and data classes will be added to support a wide variety of use cases and target populations, such as clinical quality measures, transitions of care, social determinants of health, pediatrics, behavioral health, etc.

 

Exchange and Innovation

 

Aside from establishing a new set of standards for interoperability, the ONC is also pushing for the adoption of standardized Application Programming Interfaces (APIs). These interfaces are meant to give patients more choice in care and treatment. They take the form of applications on computers and smartphones for example. For patients, APIs are supposed to make good on a promise to promote secure and more immediate access to health information to them and their providers. For EHR vendors and health plans, the adoption of APIs is meant to kickstart innovation in data sharing.

 

No Standing Still

 

An unambiguous emphasis in the proposed ruling is the prevention of information blocking. To facilitate improved data exchange and better access to healthcare data, ONC is proposing that health IT developers, health information exchanges and health information networks will incur financial penalties if they are perceived to have information blocking practices which are defined as “interfering with, preventing or materially discouraging access, exchange, or use of electronic health information.” Providers will not incur penalties, but could be subject to “appropriate disincentives.”

However its results take shape, the ONC proposal will drive the innovation and transparency needed in the healthcare industry. Having accessible, consistent electronic health information readily available from disparate sources helps to provide the full picture of the patient to the care team. Increased access, as stated in no uncertain terms within the ruling, leads to better quality care, reduced duplicate testing, prevention of hospital readmissions and lower healthcare costs.

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