Complying with data blocking rule

New federal regulations aimed at promoting interoperability and preventing data blocking took effect in early April. The companion rules aim to drive data exchange of patient medical records.

Modern Healthcare assembled a panel of experts for a webinar last month to talk about challenges and opportunities that the industry will face to comply with the rules. The following are some key takeaways.

Deven McGraw
Co-founder and chief regulatory officer
Ciitizen
Former deputy director for health information privacy at HHS’ Office for Civil Rights and acting chief privacy officer at ONC

“One of the challenges is the breadth of the definition. It is considered to be (information) blocking if it is an action or even a failure to act—an omission—that is likely to interfere with, prevent, or materially discourage access or exchange or use of electronic health information.

In an effort to ease these rules into effect, ONC has said that electronic health information is going to be limited to the information that’s in what’s called the U.S. Core Data for Interoperability v1—the USCDI—for the first 18 months of the information blocking rules. After those 18 months, essentially, anything that fits the definition of electronic health information, which ties very closely to the concept of a designated record set under HIPAA—the data that patients have the right to—is considered to be part of the EHI definition.”

Jeffrey W. Short
Attorney
Hall, Render, Killian, Heath, and Lyman

ONC laid out eight broad exceptions to its data blocking rule.

“One area I think is going to have to play out is the infeasibility exception. The infeasibility exception is where that all comes home. And in there, there’s the (return on investment) standard—what’s your return on investment of doing some of these activities, and how does that fit into the financial condition of the actor under the information blocking in that healthcare institution? If it’s a highly profitable, high-margin (facility), do they get a different standard than a critical-access hospital that’s struggling to even survive. And that’s going to be played out by the (Office of Inspector General).

Steven Chies
President
North Cities Health Care

Funding
“The funding issues are clear—staff and training. Staffing is always a critical issue in the senior-care sector. COVID hasn’t helped us very much in that area. And then being able to train individuals is a very important component. Broadband access is especially an issue. If you’re going to be transferring data, you want to be able to transfer data quickly—15% of the facilities in the skilled-care sector are in rural locations and broadband can be horrendous out there.”

Common data sets
“We’d like to see mandating all providers adopt the USCDI format. That would certainly make it easier to be able to transfer data back and forth.”

Patient identification
“As part of the original February 2019 rule, ONC talked about trying to find a solution for easy patient identification. That still remains a barrier and still remains an issue.”

Think local
“Most of the admissions for senior-care providers are going to be by known acute-care hospitals that are in their geographic region. Let’s make sure that we have the opportunity to work locally rather than have a (national) solution that creates all sorts of issues and barriers beyond just the local solutions.”

Dr. Natalie Pageler
Chief medical information officer
Stanford Children’s Health

“It was my team’s and my responsibility to educate my executive colleagues as well as the rest of the organization. I have made it a regular process (to give updates at) executive meetings. We’ve updated the board about this because it has some very significant implications for the overall governance of the organization. And then we have done educational meetings throughout the organization.

We are partnered closely with Stanford Health Care and we have had an organization-wide collaborative group with both hospitals and our compliance teams. That is our governance group. We meet regularly and have done so to get to the first deadline, but clearly … we’ve got a long way to go. Identifying the key stakeholders, who is accountable for implementing these rules, and then having the right governance group to oversee all the new information that keeps coming out is absolutely critical.”