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ONC’s Proposed Rule Aims to Improve Health IT Interoperability and Promote Patient Access

The Office of the National Coordinator for Health IT (ONC) released its proposed rule in February 2019, implementing certain provisions of the 21st Century Cures Act (Cures Act). The proposed rule is designed to “increase innovation and competition by giving patients and their healthcare providers secure access to health information and new tools, allowing for more choice in care and treatment.”

The ultimate aim of the rule—and the Cures Act—is a healthier nation; one in which everyone can easily, safely, and securely access their electronic health information (EHI). The rule signals momentum in advancing health IT interoperability—and speaks to the convergence of standards, legislative backing, and provider/payer readiness. Key interoperability players, technology, and laws are finally at the same table, at the same time.

As healthcare progresses toward a more interoperable world, it’s helpful to understand ONC’s proposed rule—key benefits, major updates, estimated timeline, and what providers can do to prepare for the final rule in early 2020.

ONC’s Proposed Rule Prioritizes Patient Access

Health IT interoperability has been challenging and elusive for a litany of political, technological, and financial reasons. In the past, the industry’s solution to the interoperability problem was additional technology standards.

ONC’s proposed rule tackles the problem in a multi-pronged way designed to improve technology standards and address business practices that interfere with securely exchanging and accessing EHI. The patient-centric rule focuses on:

  • Promoting patient access: giving patients and providers free, secure access to their structured and unstructured EHI (using an application of their choice that leverages new required API functionality).
  • Increasing innovation and competition: creating new interoperability tools that give patients more choice in their care and treatment, and implementing Cures Act information blocking provisions to prohibit business practices that prevent sharing EHI.
  • Advancing interoperability: updating the ONC Health IT Certification Program with new requirements for health IT to support additional data exchange, including establishing a US Core Data for Interoperability (USCDI) standard, new API requirements, and EHI export requirements.

ONC’s proposed rule includes updates to the 2015 Edition Health IT Certification Criteria, building on past rule-makings to advance health IT interoperability. Together, these updates are designed to reduce provider burden while simultaneously ensuring that health IT continues to advance interoperability and promote patient access.

chart showing changes to 2015 certification criteria

Preparing for ONC’s Final Rule

While the ONC addresses what health IT developers must do from a technology standpoint, providers and payers participating in various CMS programs are required to leverage that technology to advance the aims of the Cures Act.

Providers can prepare by understanding what functionality their health IT is required to support under the rule. They need to prepare to implement the new functions once they are available in order to give their patients access to their EHI using an application of their choice. Providers can also review their current signed contracts and agreements with technology providers and HIEs for clauses that may constitute information blocking, which will no longer be permissible.

Estimated Timeline for ONC’s Rule

The public comment period for ONC’s proposed rule is open until June 3, 2019. The final rule is likely to be published in early 2020, with 2020 being the pilot year (possibly partial) for the real-word testing of the technology. The deadline for implementing the new API and EHI export, and for removing gag clauses from contracts, is 24 months after the final rule is published.

ONC's Timeline of Proposed Rule Estimation

Data Belongs to the Patient

CareEvolution’s long-standing ethos that data belongs to the patient—not the technology developer or the provider—demonstrates an equally persevering commitment to improving the health of our nation’s population. This patient-centric mission is tangible in CareEvolution’s industry-leading API work, including the implementation of advanced API functionality that supports the proposed rule’s aims of improved patient access and health IT interoperability.