CHICAGO—The chief federal information technology policymaker stopped short of denouncing a recently released CMS proposed rule that patient-engagement advocates say is a step backward for their cause.
Instead, Dr. Karen DeSalvo, head of the Office of the National Coordinator for Health Information Technology at HHS, said she hopes a “call to action” by her predecessor seeking to pressure the CMS to walk back the proposed rule change encourages more patients to seek access to their electronic health records.
“I would be delighted if there were a maelstrom of requests for people to want to have access to their electronic health information and that not only spurred conversation but action,” DeSalvo said in an interview Tuesday at the Healthcare Information and Management Systems Society convention in Chicago.
“Where we are at ONC, and where I'm at personally, is (patients) having real, meaningful control over their health information, electronic and otherwise,” DeSalvo said. “It's essential to their meaningful engagement.”
Sunday at the HIMSS meeting, in a keynote speech to a group of patient-engagement practitioners, former ONC chief Dr. Farzad Mostashari said he was “taking issue” with a CMS proposed revision of a Stage 2 meaningful-use criterion in the $29.6 billion federal electronic health-record incentive-payment program.
Mostashari called for a national day of action in which patients would insist on being given electronic access to their records as a way to protest the proposed rule change and demonstrate patient demand for health information access.
The current Stage 2 provision requires that participating hospitals, office-based physicians and other “eligible professionals” induce 5% of their patients to electronically view, download or transfer their records kept in the providers' EHRs. Getting patients to be more involved in their care, including seeing, reviewing and correcting their records if need be, has long been a policy goal promoted by the ONC.
The CMS revision, however, part of a 210-page proposed rule issued Friday aiming to add more flexibility to the federal program, would require a participating provider to attest only that a single patient had used the view, download or transfer function in the provider's EHR in an entire year.
Mostashari said he's fearful that without the 5% target, providers will only perform the minimum requirement, undermining one of the “pillars of interoperability … the HIE of one,” that is, the willing patient.
The CMS' proposed rule change would not alter an ONC requirement that vendors have view, download or transfer capabilities built into the EHRs they test and certify as eligible for provider use in the EHR incentive-payment program. But DeSalvo acknowledged it will take more than technical capabilities to prompt patients to become more actively engaged with their own records.
The CMS rule is open to public comment and possible revision, “which is why inviting conversation is so critical to this,” she said. “Using any bully pulpit to spotlight that” and encourage patient demand for view, download or transfer is fine with her. “Let's encourage it; let's move well beyond 5%. Let's see that it's ubiquitous.”
Commenting on a recently released ONC report on healthcare data blocking, DeSalvo said action to address the problem could come from various federal agencies besides the ONC.
The Federal Trade Commission could enforce consumer protection laws against false advertising and restraint of trade. And HHS' Office for Civil Rights also could be called into play, since denying patients access to their medical records is a HIPAA violation.
But vendors who have engaged in data-blocking are already feeling pressure to stop, DeSalvo said.
“Since we began having this conversation there has been a tremendous amount of advancement” among data holders and EHR vendors toward working together, she said.
