Landmark data-sharing regulations from HHS' Office of the National Coordinator for Health Information Technology and CMS seek to tie healthcare providers and patients across the care continuum closer together—but historical disparities in technology adoption between healthcare sectors could pose challenges for providers in post-acute and long-term care settings.
The information-blocking and interoperability rules, provisions of the 21st Century Cures Act, were released last year but implementation was subsequently pushed back to April 2021 due to the COVID-19 pandemic.
Under the information-blocking provisions, providers are barred from blocking patients and other providers from accessing health data unless they meet one of eight specific exceptions.
The ONC's rule uses a definition for healthcare providers from the Public Health Service Act. So it applies not only to acute-care hospitals, but a broad range of providers including post-acute and long-term care facilities like nursing and home health agencies.
It could represent a notable shift for post-acute care providers, who have often struggled to receive data from referral facilities.
Historically, "healthcare has been driven by the hospitals being the keepers of all data," said John Kunysz, CEO of home healthcare provider Intrepid USA Healthcare Services.
The regulations are "long overdue," said Steven Chies, president of North Cities Health Care, a long-term and transitional healthcare provider with sites in Coon Rapids and New Brighton, Minn. He also teaches online courses on health information systems at St. Joseph's College of Maine. "It'll pull us out of the 19th century in terms of technology."
Chies said many senior-care providers exchange data with other providers—such as when receiving a patient from a hospital or when transferring a patient to an emergency department—on paper. In fact, the majority of post-acute care providers—66%—access patient records from referring facilities via fax machines, according to a 2018 report from KLAS Research.
"The post-acute setting is still highly dependent on fax," said Coray Tate, an analyst at KLAS.
Even if a post-acute care provider is on an electronic health records system, they might still be doing patient transfers on paper if their software system doesn't communicate well with the receiving facility's system.
That's why Chies is excited about provisions in ONC's rule related to application programming interfaces—protocols that allow different applications to communicate and share data with one another.
He expects the rule, which sets specific standards for APIs implemented by some healthcare software developers, to make it more likely for acute-care and post-acute care providers to use software that leverages the same data standards. That, hopefully, will allow providers from across the care continuum to more easily share information electronically.
"I've been arguing for 10 years that, without government intervention, there's not going to be a standard for interoperability," Chies said. "A government agency—or anybody—willing to step forward and put forth a standardized protocol for transferring data, is going to be a very good thing, especially for the long-term care segment."