ONC Proposed Rule to Improve the Interoperability of Health Information (NPRM)

Released in February 2019, ONC’s Notice of Proposed Rulemaking (NPRM) 1 supports seamless and secure exchange of electronic health information (EHI). The rule would enable patients to access all of their health information electronically at no cost via FHIR APIs. To accomplish this vision, the rule endorses FHIR APIs for exchanging clinical data, which will be required in certified electronic health records (EHRs), and also implements the information blocking provisions of the 21st Century Cures Act.

How 1up is Helping Organizations Comply with NPRM

To address this regulation, providers and other healthcare stakeholders are using 1up to:

  • Provide Application Access to US Core Data for Interoperability (USCDI). The revised 2015 EHR certification criteria would mean that patients using EHRs must be able to share their full clinical dataset (as defined in the USCDI) with any application of their choice via FHIR APIs. 1up can quickly help implement these FHIR API endpoints in your EHR to fulfill this measure.
  • Enable API Support for multiple patients in FHIR Bulk Data format. The proposed revisions to the 2015 Edition Base EHR definition would also require API services for which multiple patients’ data are the focus. 1upHealth is building the FHIR Bulk Data reference implementation with Boston Children’s Hospital via a $1M LEAP grant from HHS and is helping other organizations enable population health analytics across internal and external data sources. For more information on our Bulk FHIR data, click here.

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How NPRM Intersects with the CMS Patient Access Rule

Released in tandem in February 2019 with this ONC NPRM rule, the CMS Patient Access and Interoperability rule aims to improve patient access and advance electronic data exchange and care coordination. The rule places specific requirements on health plans for exchange via APIs. Both rules tie back to the 21st Century Cures Act, under which ONC and CMS have closely collaborated to advance interoperability.

ONC NPRM Rule Details

“The era of the provider controlling all of this, I think this is over… [We need a] formal path to put patients back in control of their medical data.” - Dr. Don Rucker, head of the ONC 2

The proposed ONC NPRM rule emphasizes the patient's ability to access their health information electronically (structured and/or unstructured) at no cost. The rule received over 1900 public comments 3 to be addressed in the final version. Specific key provisions of the proposed rule include:

  • Officially endorses FHIR APIs in revised EHR certification criteria
  • Requires certified EHRs use the new US Core Data for Interoperability (USCDI) in place of the Common Clinical Data Set. The USCDI expands the data types available for interoperability to include clinical notes, pediatric vital signs, patient contact information, data provenance, etc.
  • Defines seven exceptions to the definition of information blocking, including preventing patient harm, promoting security of health information and responding to requests that aren't feasible
  • Starting in 2020, requires hospitals to electronically inform physicians and other providers when their patients are admitted, discharged, or transferred
  • Requires EHR vendors to electronically export all the health information that they produce and electronically manage

References

  1. https://www.healthit.gov/sites/default/files/nprm/NPRMmediaadvisoryFactSheet.pdf
  2. https://www.the-hospitalist.org/hospitalist/article/198163/practice-management/oncs-dr-rucker-era-provider-controlled-data-over
  3. https://healthitanalytics.com/features/cms-sparks-mixed-reactions-with-interoperability-data-blocking-rules