Seema Verma, CMS Administrator Call
Overview of CMS Interoperability and 
ONC Information Blocking Proposed Rules

February 11, 2019 at 11:30 am ET

Closed to press - For CMS stakeholders only

General Message

The two proposed rules will ensure Americans will have access to their medical records in a digital format, increase seamless flow of information, reduce burden on patients and providers and foster innovation by unleashing data for researchers.
 
This is an unprecedented step toward a health care future where patients can obtain and share their health data securely and privately with just a few clicks. This is just the beginning of a data revolution that truly empowers American patients.

Context for The Rules

  • By 2026, we will be spending 1 in ever 5 dollars on health care, which will destroy our economy.

  • These rules build on MyHealthEData initiative and the overhaul of the “meaningful use” program.

  • It also builds on the launch of BB 2.0 -- which allows nearly 40M Medicare beneficiaries to share their claims data in a API format with applications to help them manage their health.

  • There are now over 1500 developers that have access to this data in a controlled development environment and 17 with actual access to BB data to manage apps. Because of this patients can use claims data to organize medications, share data with their doctors and help them understand their health better.

Interoperability Rule

Information Blocking

  • CMS will publicly expose the bad actors who are purposefully trying to keep patients from their own information.​​

  • All plans doing business doing thru Medicare, Medicaid and federal exchanges, plans must share claims and other health info including pricing with patients electronically thru an API and let them take it with them when they change plans.  

  • Making this information thru an API will allow for easier integration for use by more patients -- people can more easily share their information with caregivers, family, providers and others. Combined with 40M Medicare beneficiaries that have access to BB 2.0, this will bring the total number of patients with electronic access to their health claims data to a total of 125 million.

  • CMS uses its strongest lever – making this a Condition of Participation in Medicare -- requiring that all hospitals must send electronic notification to designated health care providers when their patients are admitted, discharged or transferred from the hospitals to improve transitions of care to improve care coordination and patient safety. 

Other Proposals

  • Requiring plans to provide electronic provider directories, including timely updates to the data

  • Care coordination for dual eligibles by increasing data sharing

Two RFIs

  1. How can CMS deal with patient matching?

  2. How can CMS improve health IT adoption in post-acute care settings?

Support of FHIR

CMS is also interested in supporting standards development, ensuring that the HIPAA designated record set is made available electronically. The proposal references the vast interoperability resource – the FHIR standard – CMS will continue to support the industry in maturing the standard that effectively shares data and puts the patient at the center.
It has been more than 2 years since the 21st Century Cures Act was passed.

Q&A

American Medical Association:

What are you doing to address the need for costs to exchange data across the system?
 
Answer:
Doctors already have routine costs for what they are extending already for electronic health records. There is an impact analysis in the rule and we look forward to understanding what the impact is for providers.

Humana:

Please provide additional color on trust exchange networks.
 
Answer:
Exchange networks must be able to exchange PHI and all applicable state and jurisdictions – must be capable of developing EHRs and exchanging EHRs.

Google:

How are you handling caregiver and trusted access for loved ones, what are the technical standards to support that access?
 
Answer:
When patients have access they can pass it along to anyone they designate / authorize. It will depend on where the patient puts their data.

Want to know more?

 

Contact Julie Barnes at julie.barnes@maverickhealthpolicy.com​

Text or call 703-304-1756

  • Requires health plans to release claims data by 2020.

  • All plans doing business doing thru Medicare, Medicaid and federal exchanges, plans must share claims and other health info including pricing with patients electronically thru an API and let them take it with them when they change plans.  

  • Making this information thru an API will allow for easier integration for use by more patients -- people can more easily share their information with caregivers, family, providers and others. Combined with 40M Medicare beneficiaries that have access to BB 2.0, this will bring the total number of patients with electronic access to their health claims data to a total of 125 million.

  • CMS is also proposing that claims data follow a patient as they move from plan to plan allowing for a single access point for patients.

  • Sharing claims data is just one piece of a health care system that seamlessly share information.

Julie Barnes, J.D. 

Phone: (703) 304-1756 

Email: julie.barnes@maverickhealthpolicy.com

P.O. Box 7117 2200 N. George Mason Drive, Arlington, VA 22207

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