Tag: 21st Century CURES Act

AHIMA and Provider Groups Call for Enhanced Security and Clarification On Information Blocking Rule

The American Health Information Management Association (AHIMA) sent a joint letter to Congressional leaders today voicing concerns that certain provisions of the Office of the National Coordinator for Health Information Technology’s (ONC’s) recent 21st Century Cures Act (Cures) proposed rule on information blocking jeopardizes goals to foster a healthcare system that is interoperable, patient-engaged and reduces burdens for those delivering care.

The letter, co-signed by seven organizations representing the nation’s clinicians, hospitals, health systems and experts in health informatics and health information management, outlines several recommendations aimed at furthering the objectives of Cures, while ensuring that the final regulations do not unreasonably increase provider burden or hinder patient care.

“We support the intent of the Cures Act to eradicate practices that unreasonably limit the access, exchange and use of electronic health information for authorized and permitted purposes that have frustrated care coordination and improvements in healthcare quality and efficiency,” said AHIMA CEO Wylecia Wiggs Harris, PhD, CAE. “However, in light of the lessons learned from the meaningful use program, we believe it is crucial that we get this right. We look forward to discussing the details of these recommendations with congressional staff and ONC.”

Recommendations outlined in the letter include: 

For additional information on these recommendations, click here.

Signatories of the letter include:

American Health Information Management Association (AHIMA)

American Medical Association (AMA)

American Medical Informatics Association (AMIA)

College of Healthcare Information Management Executives (CHIME)

Federation of American Hospitals (FAH)
Medical Group Management Association (MGMA)

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AMA, Others Seek Congressional Oversight On Information Blocking Regulations

The American Medical Association (AMA) and six other organizations have asked two congressional committees to use their oversight of the 21st Century Cures Act to improve interoperability and empower patients with meaningful health information while ensuring data is safe and secure. The letter arrives as the administration is drawing up its plans to implement the law and adopt information blocking rules.

The AMA appreciates several of the administration’s proposals, particularly related to electronic health record (EHR) certification, EHR application programming interfaces (APIs), and modifying EHR vendor business practices and behaviors.

There are, however, numerous complex, counter-intuitive proposals that jeopardize the goals Congress outlined in the Cures Act. Concerningly, many of the administration’s proposals will dramatically affect patient privacy and safety as well as as data security. The proposals also will add to physician burden and burnout.

“The administration owes it to patients, physicians, Congress and our nation to listen and act on these concerns,” said Jesse M. Ehrenfeld, M.D., chair of the AMA’s Board of Trustees. “We still have a chance to get these policies right. It is possible to improve access to medical information while promoting privacy and transparency.”

HHS Announces Next Steps In Advancing Interoperability of Health Information

The U.S. Department of Health and Human Services (HHS) today issued for public comment draft two of the Trusted Exchange Framework and Common Agreement (TEFCA) that will support the full, network-to-network exchange of health information nationally. HHS also released a notice of funding opportunity to engage a non-profit, industry-based organization that will advance nationwide interoperability.

Specifically, the documents being released for comment are: (1) a second draft of the Trusted Exchange Framework (TEF), (2) a second draft of the Minimum Required Terms and Conditions (MRTCs) for trusted exchange, and (3) a first draft of a Qualified Health Information Network (QHIN) Technical Framework. These documents will form the basis of a single Common Agreement that QHINs and their participants may adopt. This Common Agreement will create baseline technical and legal requirements for sharing electronic health information on a nationwide scale across disparate networks.

Alex Azar

“The seamless, interoperable exchange of health information is a key piece of building a health system that empowers patients and providers and delivers better care at a lower cost,” said HHS Secretary Alex Azar. “The 21st Century Cures Act took an important step toward this goal by promoting a national framework and common agreement for the trusted exchange of health information. We appreciate the comments and input from stakeholders so far and look forward to continued engagement.”

In developing a TEFCA that meets industry’s needs, HHS’ Office of the National Coordinator for Health Information Technology (ONC) has focused on three high-level goals:

ONC will maintain the TEF, while a non-profit, industry-based organization, known as the Recognized Coordinating Entity (RCE), will be awarded funds to develop, update, implement, and maintain the Common Agreement. Through this effort, ONC will define the minimum required terms and conditions needed to bridge the current differences among data sharing agreements that are preventing the flow of electronic health information.  The industry-based RCE will be tasked with developing additional required terms and conditions necessary to operationalize the Common Agreement and meet the interoperability requirements of the 21st Century Cures Act.

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Patients Can Expand Access To Clinical Trials, If They Have The Right Tools

By Komathi Stem, founder and CEO of monARC Bionetworks.

Komathi Stem

The FDA released guidance last year noting that electronic health records (EHRs) have the potential to improve clinical trials, leading to greater safety and efficacy. But tapping that potential, according to the agency, requires interoperability — the ability of two or more products, technologies or systems to 1) exchange information, and 2) to use the information that has been exchanged without special effort on the part of the user.

The healthcare industry, driven by meaningful-use requirements, is focused on wider efforts to promote interoperability. Many of them emphasize technology, including advances such as Fast Healthcare Interoperability Resources (FHIR) tools and Substitutable Medical Applications, Reusable Technologies (SMART) standards. But while the technology is crucial, it is equally as important to recognize the group of stakeholders who could play a critical role in making systems more interoperable, and thus improve the clinical trials process:

The patients themselves.

Interoperability

Interoperability has the potential to help increase care coordination, improve safety, support patients in making the most informed healthcare decisions, reduce costs, and help public health and health promotion efforts. In addition, interoperability can have a role in drug development, as the 21st Century Cures Act mandates that the FDA include Real-World Data (RWD) — data gathered during routine clinical care – in regulatory decision making. This RWD can be in part derived from the EHR-generated data, standardized and shared through the interoperability process.

The growing availability of information (digital health data is increasing by 48 percent each year) creates the potential for better patient care, including improved clinical trials. Unfortunately, despite strides made in interoperability, data in medical records are still too often packaged in ways (i.e., handwritten notes and medical device feeds) that are hard to share or standardized.

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Implementing the 21st Century Cures Act: Making Electronic Health Information Available to Patients and Providers

On Tuesday, March 26, the Senate health committee will hold a hearing on implementation of the electronic health information provisions in the 21st Century Cures Act.

In the Cures Act, Congress took steps to help improve the exchange of electronic health information. Last month, the Department of Health and Human Services (HHS) released two rules to define information blocking—so it is clear when one system is purposefully not sharing information with another—and to give patients more control over their records and providers more information so they can better treat their patients. This hearing will be about the proposed new rules and efforts to improve electronic health records and make health information more accessible.

Chairman Lamar Alexander (R-Tenn.) said of the new proposed rules: “These proposed rules remove barriers and should make it easier for patients to more quickly access, use, and understand their personal medical information. It should also unleash new ways of helping doctors and other medical providers to make sense of that information in ways that lead to better health care experiences, better outcomes, and lower costs for patients. Our committee will continue careful oversight of these new rules which affect almost every American and are an important result of the bipartisan 21st Century Cures Act.”

The Senate health committee had six hearings in 2015 to explore ways to get our nation’s system of health information technology out of a ditch and make it useful for doctors and patients. The committee then authored the 21st Century Cures Act which directed HHS to make proposals to improve electronic health records.

Keep Your Eye On 4 Trends Revealed At HIMSS19

By Sheri Stoltenberg, CEO, Stoltenberg Consulting.

Sheri Stolenberg

The 2019 HIMSS Annual Conference may be over, but that doesn’t mean an end to the pressing challenges and trends discussed at Orlando’s Orange County Convention Center. More than 42,500 people attended the conference — the majority of whom were C-suite executives and HIT professionals taking full advantage of the healthcare IT industry’s largest opportunity for networking, product promotions, continuing education and major announcements.

As always, there were a few subjects during HIMSS19 that generated significant buzz. Here are four of those trends that will remain key topics throughout the next year:

Healthcare data exchange

The release of two long-anticipated proposed rules on information blocking came just as HIMSS19 convened. The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) unveiled proposals that would require healthcare providers and plans to implement open data sharing technologies to support transitions of care. The first focuses on standardized application programming interfaces (APIs) and carries forward provisions from the 21st Century Cures Act.

Those associated with Medicaid, the Children’s Health Insurance Program (CHIP), Medicare Advantage and Qualified Health Plans in the federally-facilitated exchanges would have to provide patients with immediate electronic access to medical claims and other health information by 2020. Under a latter proposal, health information exchanges (HIEs), health IT developers and health information networks (HINs) can be penalized up to $1 million per information blocking violation, but providers are not subject to fines.

The goal of the proposals is to consider care across the entire continuum, giving patients greater control and understanding of their health journeys. This is interesting, given that HIMSS attendees who responded to Stoltenberg Consulting’s seventh annual HIT Industry Outlook Survey noted “lack of system interoperability” as one of their biggest operational burdens, and “leveraging meaningful patient data” as the IT team’s most significant hurdle this year. Thus, overcoming these challenges to meet the newly proposed mandates will likely dominate discussions during the remainder of 2019.

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What the Hell Is Going On with Healthcare Interoperability?

Road Closed, Construction, Detour, RoadThe Department of Health and Human Services (HHS) filed its annual year-end report to Congress at the start of 2019. The 22-page report summarized nationwide trends in health information exchange in 2018, including the adoption of EHRs and other technologies that support electronic access to patient information. The most interesting takeaway has to do with the ever-elusive healthcare interoperability.

According to the report, HHS said it heard from stakeholders about several barriers to interoperable access to health information remain, including technical, financial, trust and business practice barriers. “These barriers impede the movement of health information to where it is needed across the care continuum,” the report said. “In addition, burden arising from quality reporting, documentation, administrative, and billing requirements that prescribe how health IT systems are designed also hamper the innovative usability of health IT.”

To better understand these barriers, HHS said it conducted multiple outreach efforts to engage the clinical community and health IT stakeholders to better understand these barriers. Based on these takeaways, HHS said it plans to support, through its policies, and that the health IT community as a whole can take to accelerate progress: Focus on improving interoperability and upgrading technical capabilities of health IT, so patients can securely access, aggregate, and move their health information using their smartphones (or other devices) and healthcare providers can easily send, receive, and analyze patient data; increase transparency in data sharing practices and strengthen technical capabilities of health IT so payers can access population-level clinical data to promote economic transparency and operational efficiency to lower the cost of care and administrative costs; and prioritize improving health IT and reducing documentation burden, time inefficiencies, and hassle for health care providers, so they can focus on their patients rather than their computers.

Additionally, HHS said it plans to leverage the 21st Century Cures Act to enhance innovation and promote access and use of electronic health information. The Cures Act includes provisions that can: promote the development and use of upgraded health IT capabilities; establish transparent expectations for data sharing, including through open application programming interfaces (APIs); and improve the health IT end user experience, including by reducing administrative burden.

“Patients, healthcare providers, and payers with appropriate access to health information can use modern computing solutions (e.g., machine learning and artificial intelligence) to benefit from the data,” HHS said in its report. “Improved interoperability can strengthen market competition, result in greater quality, safety and value for patients, payers, and the healthcare system generally, and enable patients, healthcare providers, and payers to experience the promised benefits of health IT.”

Interoperability barriers include:

Elsewhere, the Center for Medical Interoperability, located in Nashville, Tenn., is an organization that is working to promote plug-and-play interoperability. The center’s members include LifePoint Hospitals, Northwestern Memorial Healthcare, Hospital Corporation of America, Cedars-Sinai Health System, Hennepin Healthcare System, Ascension Health, Community Health Systems, Scripps Health, and UNC Health Care System.

Its mission is “to achieve plug-and-play interoperability by unifying healthcare organizations to compel change, building a lab to solve shared technical challenges, and pioneering innovative research and development.” The center stressed that the “lack of plug-and-play interoperability can compromise patient safety, impact care quality and outcomes, contribute to clinician fatigue and waste billions of dollars a year.”

More interoperability barriers identified

In a separate study, “Variation in Interoperability Among U.S. Non-federal Acute Care Hospitals in 2017,” showed additional difficulty integrating information into the EHR was the most common reason reported by hospitals for not using health information received electronically from sources outside their health system. Lack of timely information, unusable formats and difficulty finding specific, relevant information also made the list, according to the 2017 American Hospital Association (AHA) Annual Survey, Information Technology Supplement.

Among the explanations health systems provided for rarely or never using patient health information received electronically from providers or sources outside their health system:

Hospitals, when asked to explain their primary inability to send information though an electronic exchange, pointed to: Difficulty locating providers’ addresses. The combined reasons, ranked in order regardless of hospital classification (small, rural, CAH or national) include:

Additional Barriers

The report also details other barriers related to exchanging patient health information, citing the 2017 AHA survey:

“Policies aimed at addressing these barriers will be particularly important for improving interoperable exchange in health care,” the report concluded. “The 2015 Edition of the health IT certification criteria includes updated technical requirements that allow for innovation to occur around application programming interfaces (APIs) and interoperability-focused standards such that data are accessible and can be more easily exchanged. The 21st Century Cures Act of 2016 further builds upon this work to improve data sharing by calling for the development of open APIs and a Trusted Exchange Framework and Common Agreement. These efforts, along with many others, should further improvements in interoperability.”

What healthcare leaders are saying about interoperability

While HHS said it conducted outreach efforts to engage health IT stakeholders to better understand these barriers, we did too. To further understand what’s currently going on with healthcare interoperability, read the following perspectives from some of the industry’s leaders. If there’s something more that you think must be done to improve healthcare interoperability, let us know:

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Key Takeaways From CMS/ONC Officials Regarding New Interoperability Proposed Rule

Following the release of its proposed new rules designed to improve the interoperability of electronic health information, members of leadership from the Centers for Medicare & Medicaid Services (CMS) hosted a call to provide additional detail about the proposed rule, and to answer questions from the media. The following includes the key takeaways from the officials hosting the call.

CMS Administrator - Seema Verma
Seema Verma

Seema Verma, Administrator, CMS

Don Rucker
Don Rucker

Don Rucker, MD, National Coordinator for Health Information Technology (ONC)

Eric D. Hargan
Eric D. Hargan

Eric Hargan, deputy secretary, HHS Office of the Secretary

Choosing the Right Electronic Visit Verification Solution for Your Home Care Agency

By John Cunningham, marketing and sales director, myGeoTracking.

John Cunningham

On December 2016, the 21st Century CURES Act was signed into law, resulting in new regulations for the home health industry. The CURES Act mandates the use of electronic visit verification, or EVV, for all Medicaid-funded personal care services.  On Jan. 1, 2019, these new federal requirements for EVV went into effect for personal care services.

EVV is a method of utilizing electronic technology to capture point of service information related to the delivery of in-home services, such as:

Types of EVV

There are three ways through which Home Health Care provider companies can comply to the new regulations involving CURES Act. Let’s take a closer look at them.

Biometric recognition

This type of EVV solution uses a dedicated hardware device which is used to record caregiver’s scan of fingerprints or record voice samples to register visits.

Biometric recognition may seem like a good solution to comply with EVV at first, but this system has some drawbacks. These devices are expensive and each care recipient has to have a dedicated biometric device installed on their premises. It can be an inconvenience to both the business and the patient.

Telephony

Telephony method is commonly used in the home setting and don’t require the companies to install or service any devices. To record a visit with this method, the caregiver uses a recipient’s landline phone to dial a toll-free number at the start and completion of service delivery.

Based on a recent National Health Interview Survey (NHIS), it was found that almost half of the US household do not have a landline and are rapidly losing relevance. Smartphones have taken over and landlines are becoming obsolete. The decline of landlines makes this option historical and therefore a weak contender as an effective EVV solution.

Mobile technology (phone and tablets)

The modern EVV solution for all types of caregivers uses the app on the mobile devices, specifically smartphones and tablets. Most modern mobile devices have GPS for location-based Electronic Visit Verification via GPS tracking and geofencing.

Smartphones and tablets are constantly evolving and are becoming more powerful, and with increasing affordability of key technologies like mobile apps, sensors and cloud technology, the mobile technology offers to be the most future-proof EVV option.

Mobile technology EVV solutions go far beyond simple proof of visit. These more comprehensive solutions frequently combine mobile applications with back-office portals, providing additional functionalities:

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