The College of Healthcare Information Management Executives, representing healthcare CIOs, is urging federal healthcare policy officials to go slow with dual interoperability and information blocking rules by first publishing interim final rules rather than final rules.
And once those rules are published, CHIME wants healthcare providers to have three years to implement them.
In 44 pages of comments to the Office of the National Coordinator for Health IT (ONC) and Centers for Medicare and Medicaid Services (CMS), CHIME said it “strongly supports the overall intent of the CMS and ONC rules” but wants to ensure providers have adequate development time and the capacity to utilize the data received.
ONC unveiled its information blocking rule (PDF) back in February. The proposed rule, mandated by the 21st Century Cures Act, was intended to boost interoperability by defining exceptions to data blocking and fines that may be associated with the practice.
CMS also released a proposed rule (PDF) taking aim at data blocking.
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CHIME submitted the comments in collaboration with affiliate organizations the Association for Executives in Healthcare Information Technology (AEHIT) and the Association for Executives in Healthcare Information Applications (AEHIA) which together represent 4,000 health IT professionals.
ONC should give providers three years to absorb changes from updates to certified technology and CMS should allow three years for providers to update their admission, discharge and transition updates.
In addition, as it relates to the information blocking rule, CHIME recommends that healthcare providers should not be subjected to penalties reserved for other entities, such as vendors. Penalties create disincentives for providers to participate in information sharing, CHIME said in its comments.
In the 21st Century Cures Act, Congress outlines four sets of actors subject to the information blocking provisions: providers, health IT developers, health information exchanges (HIEs) and health information networks (HINs). Congress also outlines a penalty structure; one for providers, and other for the remaining three sets of actors.
Vendors, HIEs and HINs are subject to penalties for information blocking as high as $1 million per violation in civil monetary penalties.
Even if a provider is acting—in addition to serving primarily as a provider—as one of these other three types of actors, they are doing so to foster patient care and should not be subject to the penalties reserved for developers, HIEs and HINs, CHIME said. “Subjecting them to the up to $1 million per information blocking penalty creates significant risks to the healthcare system,” the industry group said.
If providers are subjected to these civil monetary penalties, there could be unintended consequences, especially for smaller and mid-sized providers who could deduce that if they will be treated as an HIE they may not be able to withstand a $1 million penalty.
“We worry a punitive policy of this nature could also further diminish rural provider access and could unintentionally lead to additional hospital consolidation,” CHIME said. The proposal also would conflict with the administration’s intentions to bolster competition in the health IT marketplace, the industry group said.
CHIME also recommends that ONC adopt an entirely new edition for certification rather than updating the 2015 certification for health IT. This issue has been brought up during the Health Information Technology Advisory Committee (HITAC) meetings with HITAC also recommending ONC update to a new edition. The proposed rule would result in broad-sweeping changes to the 2015 edition for certification and not updating to a new edition will create confusion, HITAC said.
Additional recommendations included:
- A ramp-up period/glide path for those providers who did not qualify for HITECH’s EHR incentives, especially those who do not currently have certified products.
- App developers, companies managing the app ecosystem and prescription drug monitoring programs (PDMPs) also should be required to meet information blocking requirements and should be included in either the categories of HIEs and HINs, depending upon the type of action they perform.
- Add patient matching to the certification requirements that health IT vendors must meet. At a minimum, vendors should be required to attest to their matching rate; make it a violation under data blocking not to share a patient matching rate.
- Engage stakeholders to develop more innovative incentives (financial or otherwise) which encourage better information sharing between acute settings of care and PAC, such that it results in effective “moments of sharing."
As part of the information blocking rule, ONC developed seven exceptions. With regard to the exception to information blocking focused on protecting the privacy of patient data, CHIME believes the exception as written could create unnecessary administrative complexity and burdens. The exception could lead to oversharing of information as not to invoke the information blocking provisions.
CHIME urges that providers only be required to meet existing requirements under HIPAA. Or, if that is not possible, CHIME urges HHS to amend and align the HIPAA rules.