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CMS Proposal Targets Information Blocking, Patient Data Access

The proposed rules double down on the MyHealtheData initiative and call for an end to patient information blocking.

information blocking patient data access

By Sara Heath

- Today the Centers for Medicare & Medicaid Services (CMS) announced the Interoperability and Patient Access Proposed Rule, which seeks to enable easier patient data access and health information exchange. This announcement comes ahead of the festivities at the HIMSS19 conference held this week in Orlando, Fl.

Specifically, the rule proposes updates to the MyHealtheData initiative, which CMS announced during last year’s HIMSS conference. The MyHealtheData initiative established the agency’s commitment to promoting patient data access and data ownership.

Specifically, CMS advocated for patients accessing their own digital medial records and transmitting that data to authorized family members, caretakers, providers, or researchers.

“This is just the beginning of a digital data revolution that truly empowers the American patient,” said CMS Administrator Seema Verma during a press call. “Together, these two groundbreaking rules ensure Americans have access to their medical records in a digital format, increase the seamless flow of information, reduce burden on patients and providers, and foster innovation by unleashing data for researchers and other innovators.”

As a part of recommitting to the MyHealtheData initiative, CMS proposed updates to Blue Button 2.0, a program which calls on patient access to their own claims data through the use of application programming interfaces (APIs).

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Last year, CMS established mandates requiring all Medicare plans to provide patients with access to claims data and the ability to transmit that data to entities of patients’ choosing. That movement sparked nearly 15,000 health IT developers to create applications to enable patient data access, Verma said.

“Today we are doubling down on our commitment to empower patients by requiring health plans to follow our lead with releasing claims data,” Verma explained. “We have proposed that by 2020, all health plans doing business in Medicare and Medicaid and through the federal exchanges be required to share claims and other health information with patients electronically through an API, and allow those patients to take their information with them when they change plans.”

“Making this information available through an API will allow easy integration for use by more patients allowing them to be true partners in their healthcare,” she continued. “The proposal would enable them to more easily share their information with providers, families, caregivers, and others.”

In addition to outlining paths to better patient data access, CMS also proposed systems to allow for better care coordination. Specifically, the agency discussed strong policies around information blocking, or the practice of withholding medical information from relevant stakeholders.

Information blocking ultimately hurts the patient, Verma suggested during her press call discussing the proposed rule. Information blocking hampers care coordination efforts, which can cause patient safety incidents. Additionally, information blocking – often done under the guide of adhering to HIPAA requirements – can reduce patient care access.

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The agency plans to crack down on information blocking by making information about those engaging in the practice more publicly available.

“We’re also putting an end to information blocking,” Verma said on the call with reporters.

“The days of holding a patient’s data hostage are over. Our proposed rule includes a policy to publicly identify doctors, hospitals, and other healthcare providers who engage in information blocking. Simply put, we’re going to expose the bad actors who are purposefully trying to keep patients from their own information. Patient data doesn’t belong to the doctor, hospital, or electronic health record. It belongs to the patient.”

CMS plans to use data gathered through the Merit-based Incentive Payment System (MIPS) program. MIPS reporting requires all participants to answer three questions regarding information blocking. If an entity answers “yes” to any of those questions, that will be publicly reported upon, Verma said.

The agency ultimately plans to create more seamless data exchange and health data interoperability via these proposed regulations. At the center of these efforts are patients, who benefit from better care, lower costs, and more ownership of their health when there are fewer obstacles to their own data.

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“For far too long, electronic health information has been stuck in silos and inaccessible for healthcare consumers,” Verma said in a written statement.

“Our proposals help break down existing barriers to important data exchange needed to empower patients by giving them access to their health data,” she continued. “Touching all aspects of healthcare, from patients to providers to payers and researchers, our work leverages identified technology and standards to spark new opportunities for industry and researchers while improving healthcare quality for all Americans. We ask that members of the healthcare system join forces to provide patients with safe, secure access to, and control over, their healthcare data.”

CMS also issued three requests for information as they pertain to patient data exchange. The agency plans to collect information about how to improve patient matching, reduce care coordination burdens for patients and providers, and deliver on value-based healthcare.

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