New information technology and changing expectations of healthcare delivery are quickly ushering in a new era of health information sharing. This is evident to all of us who use patient portals, telehealth, remote monitoring technology, electronic fitness monitoring devices, and any one or more of the health applications out there in the ether. There has been a figurative explosion of technology enabling quick and easy collection and sharing of consumer health information.
This is no less the case in the healthcare regulatory space. Interoperability has been a worthy but elusive ambition for some time now but the advent of COVID, changing consumer demands, and modern technology are quickly turning ambition into reality. So what I am talking about here? I’m thinking of the 21st Century Cures Act and its emphasis on interoperability as the catalyst for the current push on information sharing. I’m not saying this was the first piece of legislation to push the information sharing agenda, not at all, but it does represent a significant leap forward in information sharing evolution.
What’s so special about the 21st Century Cures Act, you ask? Great question! And the truth is, there’s so much in this piece of legislation that’s important including provisions around interoperability, information sharing, and information blocking. It also makes reference to something called “USCDI Data Elements” and “FHIR.” Honestly, reading it is something akin to reading a secret code that turns out to be a whole new language. So let’s break it down!
A key feature of the 21st Century Cures Act is its emphasis on making health information more accessible both to patients and their representatives and to providers who are involved in providing treatment and care to patients. If you take away anything from this blog it should be that policymakers are intent on making it easier for patients to access their data and for health care providers to share health information about patients they have in common. But how to make this happen?
First, the 21st Century Cures act bans what’s called information blocking. The Office of the National Coordinator (ONC) defines information blocking as “a practice by a health IT developer of certified health IT, health information network, health information exchange, or health care provider that, except as required by law or specified by the Secretary of Health and Human Services (HHS) as a reasonable and necessary activity, is likely to interfere with access, exchange, or use of electronic health information (EHI).” To put it simply, information blocking is any activity that prevents that prevents access, exchange, or use of patient health information and to which none of the rule’s exceptions apply. In other words, unless a regulatory exception applies, any failure to share patient information with a patient or health care providers involved in a patient’s care could be considered information blocking.
But what patient information are we talking about – does a health care provider need to share everything under the sun? Good point, I say, and this brings me to my second point. The 21st Century Cures Act specifies that only certain data elements must be shared, i.e., those included in the United States Core Data for Interoperability (USCDI). There are too many of those elements to list here and they’re changing but you can find out more on the ONC website. USCDI data elements started out with basic demographic and clinical information about a patient but is being expanded to also include information about social determinants of health. This is all to say that the 21st Century Cures Act requires the sharing of any patient information that is listed as a category in the USCDI and failure to share this information (subject to any exceptions) could be considered information blocking. Note: as of October 6, 2022, all patient electronic health information must be capable of being shared, exchanged, and used; this is a much broader category of health information than is specified in the USCDI.
Ok, so we know we have to share patient information and we know what information we need to share but how to share it? This is our third and possibly trickiest step on the road to the future of information sharing. Health care providers across the country use all different kinds of EHRs to hold patient information and most of these systems are built using different kinds of computer or electronic coding language. Think of someone who only speaks German, another who speaks Swahili, and another who speaks Vietnamese. Three different people whose individual languages enable them to communicate in their home environments but who cannot communicate with one another. EHRs work similarly in that they’re great at communicating in their “home environments” but not with one another. This makes the communication of information between different health care providers involved in a patient’s care difficult, if not impossible, and has implications for the safety and effectiveness of patient care. It also poses a challenge for information sharing.
Alas, there is a solution and it’s called Fast Healthcare Healthcare Interoperability Resources (FHIR). The easiest way to explain FHIR is to describe it as a programming or coding language – but a universal coding language that can be used to enable different EHRs to communicate with one another. Going back to our three international speakers, it would be as if suddenly each speaker could speak their native language and English! The group would then have a language in common and could communicate. The same principle applies here: FHIR is the common language that, when adopted, would enable the sharing of information between healthcare providers, payers, and health information exchanges (subject to HIPAA requirements, of course).
FHIR would also enable increased information sharing with patients. Remember, the information sharing rules apply to the sharing of health information with patients. And why is it important to use FHIR to share information with patients? This brings me to my third and last point. Remember, FHIR is a universal coding language. “Universal” means it’s used in a variety of electronic applications, software, and devices in health care, banking, and in so many of the apps we currently use. That the coding language can communicate with a wide range of electronic devices is important because the information sharing rules in the 21st Century Cures Act mandates that health information must be provided to patients in whatever format they request (subject to defined exceptions). This means that if a patient asks for information to be sent to a health application of their choice, the provider needs to make every effort to honor this request…and FHIR can help make that happen!
Here at Net Health, we appreciate the information sharing rules are complicated and that it’s not easy to see what it all means. For this reason, we have subject matter experts on staff with expertise in information sharing requirements and who work with our application development teams to promote effective information sharing functionalities in our products, including the use of FHIR.