The U.S. Department of Health and Human Services (HHS) has finalized two transformative rules for patient access to health data regarding interoperability and information blocking.

These final rules are extensive healthcare data sharing policies the federal government has implemented, requiring both public and private entities to share health information between patients and other parties while keeping that information private and secure. 

The final rule identifies and finalizes the reasonable and necessary activities that do not constitute information blocking while establishing new rules to prevent “information blocking” practices (e.g., anti-competitive behaviors) by healthcare providers, developers of certified health IT, health information exchanges, and health information networks as required by the Cures Act.

Currently, many EHR contracts contain provisions that either prevent or are perceived to prevent users from sharing information related to the EHRs in use, such as screen shots or video. The ONC final rule updates certification requirements for health IT developers and establishes new provisions to ensure that providers using certified health IT have the ability to communicate about health IT usability, user experience, interoperability, and security including (with limitations) screenshots and video.

The final rule also establishes secure, standards-based application programming interface (API) requirements to support a patient’s access and control of their electronic health information. APIs are the foundation of smartphone applications (apps). As a result of this rule, patients will be able to use their electronic health information from their provider’s medical record for free, using the smartphone app of their choice.

This CMS final rule requires health plans in Medicare Advantage, Medicaid, CHIP, and through the federal Exchanges to share claims data electronically with patients.

Beginning January 1, 2021, Medicare Advantage, Medicaid, CHIP, and, for plan years beginning on or after January 1, 2021, plans on the federal Exchanges will be required to share claims and other health information with patients in a safe, secure, understandable, user-friendly electronic format through the Patient Access API. With more complete data in their hands, patients can be more informed decision makers leading to better informed treatment.

This Patient Access API will allow patients to access their data through any third-party application they choose to connect to the API and could also be used to integrate a health plan’s information to a patient’s electronic health record (EHR). By requiring their relevant health information including their claims to be shared with them, patients can take this information with them as they move from plan to plan, and provider to provider throughout the healthcare system.

For more information on the ONC final rule, visit: https://healthit.gov/curesrule.
For more information on the CMS final rule, visit: https://www.cms.gov/newsroom/fact-sheets/interoperability-and-patient-access-fact-sheet.
To view the CMS final rule, visit: https://www.cms.gov/Regulations-and-Guidance/Guidance/Interoperability/index.
To view the ONC final rule, visit: https://healthit.gov/curesrule.