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CMS proposes new interoperability rules to close care gaps and improve data sharing

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In 2018, the Centers for Medicare & Medicaid Services (CMS) announced a new initiative, My HealthEData, that would “empower patients by giving them control of their healthcare data, and allowing it to follow them through their healthcare journey.” The initiative was led by the White House Office of American Innovation and included participation by the Department of Health and Human Services (HHS), CMS, Office of the National Coordinator for Health Information Technology (ONC), and National Institutes of Health (NIH), as well as the Department of Veterans Affairs (VA).

In February 2019, CMS proposed policy changes to support the My HealthEData initiative, including new interoperability rules designed to close care gaps to improve data sharing between physicians and patients. The Interoperability and Patient Access Proposed Rule “outlines opportunities to make patient data more useful and transferable through open, secure, standardized, and machine-readable formats while reducing restrictive burdens on healthcare providers.”

Some of the proposed changes and updates include:

  • Patient Access Through Application Programming Interfaces (APIs)
  • Health Information Exchange and Care Coordination Across Payers
  • API Access to Published Provider Directory Data
  • Care Coordination Through Trusted Exchange Networks
  • Improving the Dual Eligible Experience by Increasing Frequency of Federal-State Data Exchanges
  • Public Reporting and Prevention of Information Blocking
  • Provider Digital Contact Information
  • Revisions to the Conditions of Participation (CoPs) for Hospitals and Critical Access Hospitals
  • Advancing Interoperability in Innovative Models

At the same time, the ONC proposed a rule that “places a strong focus on a patient’s ability to access their health information through a provision requiring that patients can electronically access all of their EHI (structured and/or unstructured) at no cost.” Regarding the CMS proposed rule and the ONC proposed rule, HHS Secretary Alex Azar said, “These proposed rules strive to bring the nation’s healthcare system one step closer to a point where patients and clinicians have the access they need to all of a patient’s health information, helping them in making better choices about care and treatment.”

In addition to the policy proposals, CMS is releasing two Requests for Information (RFIs) to obtain feedback on interoperability and health information technology (health IT) adoption in Post-Acute Care (PAC) settings, and the role of patient matching in interoperability and improved patient care.

CMS will accept comments on the major provisions in this proposed rule and the RFIs (CMS-9115-P) until early April (exact date will be updated upon posting at the Federal Register); it can be downloaded from the Federal Register at: