Providers, payers unprepared for data blocking, interoperability rules: Accenture survey

Doctor computer medical records
About half of technology executives (53%) at healthcare providers and payers say they are "somewhat familiar" with proposed rules that require greater patient access. (Getty/BrianAJackson)

As part of proposed rules released by federal policymakers in February, the Trump administration wants to give 125 million patients electronic access to their medical claims information by 2020. 

But there may be a hitch to implementing these changes as most healthcare organizations lag in awareness and preparedness for compliance, according to a new survey.

One in six (17%) healthcare executives are “completely unaware” of new legislation that requires greater patient access to healthcare records and sharing of such recordswith two-thirds (65%) only “somewhat” or “vaguely” familiar, a new Accenture survey finds.

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Of the healthcare executives surveyed, only 18% said they are “very familiar” with the implications of the regulations.

The Office of the National Coordinator for Health IT (ONC) released its proposed information blocking rule (PDF) in February that outlines seven exceptions to the prohibition against information blocking and provides standardized criteria for application programming interface (API) development.

The Centers for Medicare & Medicaid Services (CMS) also issued a proposed interoperability rule (PDF) that requires insurers participating in CMS-run programs like Medicare, Medicaid and the federal Affordable Care Act exchanges by Jan. 1 to have the capability to give 125 million patients electronic access to their personal health information at no cost to patients.

RELATED: HIMSS19: Seema Verma says proposed information blocking rules with 2020 deadlines 'realistic'

The new rules, which have not been finalized, are a centerpiece of the 21st Century Cures Act and are designed to drive increased efficiency and transparency in healthcare through a variety of measures, including preventing information blocking and expanding how patients can access their healthcare information. Organizations that do not comply with the new regulations—which apply to essentially any organization handling patient medical recordscould face substantial penalties.

Accenture surveyed 76 chief information officers, chief technology officers and VPs of information technology at U.S. healthcare providers and healthcare payers with more than $1 billion in annual revenue. 

Healthcare payers appear better informed than healthcare providers, with 26% of healthcare payers saying they are “very familiar” with the rules compared to 16% of providers, the survey found.

Only 5% of healthcare providers believe their organization is “very prepared” for the new rules, compared to 26% of payers who share this belief. 

“Our survey findings are a wake-up call for health organizations and agencies that remain relatively uninformed about the regulations or who are not actively preparing. Complying with the regulations will provide them with a major opportunity to enhance the services they provide and to fundamentally improve consumer engagement in their healthcare," said Andy Truscott, managing director and technology consulting lead in Accenture’s Health practice and a member of U.S. federal government advisory groups on health IT and Health Level Seven (HL7).

According to the survey, 40% of executives believe the requirements will have little or no impact on the IT operations of their organization, despite the legislation’s focus on technology requirements. And 30% see little impact on their organization’s ability to meet the needs of their patients and customers.

RELATED: HIMSS19: ONC, CMS officials outline the framework for interoperability, the use of APIs, FHIR

Industry groups say the data blocking and patient access regulations, as proposed, will be a seismic shift for the healthcare industry and have voiced strong concerns about the implementation timelines. Seven major healthcare industry groups, including the American Medical Association, the Federation of American Hospitals and the Medical Group Medical Association, are calling for federal policymakers to make major changes to the proposed regulations, including delaying the publication of a final rule.

These same groups also have appealed to congressional leaders to help slow down the proposed interoperability rules. The groups cited concerns about patient data privacy, the implementation timelines and increased burden on clinicians.

Implications for organizations

Healthcare providers, insurance companies and other health organizations handling patient medical records need to become well-versed in the upcoming rules, according to Accenture leaders.

The development of compliance plans and preparations needed to reach compliance in 2020 should be a priority.

RELATED: Health IT stakeholders calling for ONC, CMS to 'go back to the drawing board' on interoperability rules

Healthcare organizations also can take this as an opportunity to use the new regulatory framework to improve services and value to their customers—patients, insurance plan members, Medicaid beneficiaries, partner agencies and programs, Truscott said.

Accenture recommends that healthcare organizations take the following steps to prepare for the new regulations:

  • Ensure their technology and compliance leadership are familiar with the new rules,
  • Assess and analyze their organization’s current interoperability provisions,
  • Complete gap analyses and develop remediation plans for a 12-18 month timeframe,
  • Manage communications—internally and externally—to help healthcare professionals and consumers adapt to the new rules.

Medicaid agencies, state health information exchanges and state chief information officers will also be impacted by the new law. 

“The new regulations will have major implications for public sector health entities, including Medicaid departments, state health information exchanges, and state chief information officers,” Phil Poley, Accenture managing director for public sector health, said in a statement. “These organizations will need to understand what the regulations mean for them in terms of technology requirements, processes and serving their customers, which include citizens and organizations alike."

He added, "Given the timetable and requirements for compliance, they need to be in heavy preparation and planning mode now.”

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