This year, the US Department of Health and Human Services (HHS) plans to release rules to enforce the information blocking provisions of the 21st Century Cures Act. The provisions, written by the Office of the National Coordinator for Health Information Technology (ONC), are already in effect, and prohibit providers, health information networks, and health IT developers of certified products from interfering with the access, exchange, or use of electronic health information (EHI).
This full definition of EHI includes all electronic information that would be considered part of a designated record set under HIPAA, including both clinical and billing information. (For more on the definition of EHI, see AHIMA’s joint report on: Defining EHI and the Designated Record Set in an Electronic World, written in collaboration with the EHRA and AMIA.)
To better explore the current state of information blocking compliance among its membership, AHIMA worked with an outside firm, L&M Policy Research, to conduct a study that included structured interviews with health information (HI) professionals and other compliance team members from 10 hospitals and health systems and one release of information vendor. The interviewees represented a range of facilities of various sizes from diverse communities across the country.
The Role of HI Professionals
It became clear from the study that HI professionals play a key role in information blocking compliance because they are highly trained in the latest information technology applications and understand the workflow process in healthcare provider organizations, and are vital to the daily operations management of health information and electronic health records (EHRs).
In some organizations, these professionals have a lead role in governance. Other roles included interpreting the rules and operationalizing them throughout the organization. HI professionals served as “information blocking navigators,” educators, and key subject matter experts with training and credentialing in health information management.
One interviewee at study participant Mass General Brigham, a Massachusetts-based health system, noted: “I don’t think anybody in our organization is surprised that [health information management (HIM)] is involved in this. I think people just look to us. It’s health information, it has to do with the record, it has to do with privacy, it has to do with documentation, patient access. It's kind of…ours. Who else would own it?”
Ensuring information blocking compliance also includes supporting a culture of appropriate information sharing to ensure people and providers have access to information needed to support health and care.
For example, at CommonSpirit, one of the nation’s largest nonprofit healthcare systems spanning multiple states, the HI team worked with others to reinforce the culture of information sharing through education emphasizing that the goal of compliance is to consider how to best share information appropriately. The core team provided broad staff training and developed over 30 customized worksheets for each of their markets, made analysts available to meet with subgroups, updated designated record set(s), and provided a centralized inbox to triage questions.
Information Blocking is a Team-based Sport
In all cases, however, effective implementation involved a team-based approach with multiple, cross-functional departments engaged, including compliance, legal, IT, clinical champions, and finance, among others. On top of that, leadership support allows for the team to work across the organization and have the necessary resources and priority. In one case, lack of leadership support limited the role of HIM in compliance.
Organizations Are Moving Ahead …
The interviewees took their own paths toward implementation, but most used a cross-functional work group to coordinate their compliance activities. That work included:
- Taking an inventory of where information resides;
- Understanding current capacity of EHR(s) and patient portal(s);
- Reviewing the designated record set and implications for information blocking compliance;
- Understanding varying state privacy obligations in relation to the information blocking rule;
- Developing information sharing policies;
- Identifying and managing an information blocking resource center;
- Ensuring ongoing communication, training, and education;
- Reinforcing an organizational culture of authorized information sharing; and
- Tracking and ongoing monitoring of EHI requests with clear documentation.
…But Questions Remain
Interviewees expressed concern about the complexity of the federal rules and expressed a desire for additional implementation guidance. Among other grey areas are how to balance the mandate to share information against existing federal, state, and local requirements related to the privacy of health information.
ONC is clear that privacy obligations must still be met, even as it emphasizes the obligation to share health information with those that have a right to receive it. Interviewees also reported that clinicians often express concern about sharing information about potentially life-changing diagnoses in advance of a clinical visit. And, the sheer amount of information included in the definition poses additional challenges – particularly given limitations in the ability of today’s technology to support information sharing and allow for withholding sensitive information.
While the regulations do offer exceptions tailored to some of these issues, including privacy, preventing harm, and infeasibility, the exceptions raise other issues, such as educating clinicians and others on the appropriate use of the exceptions and how best to document their use. As the federal government moves forward with enforcement, it will be important for AHIMA and other stakeholders to seek clarification and additional guidance.
AHIMA has collaborated with The Sequoia Project to offer a workshop series about the information blocking rules and good practices for compliance. To register or access on-demand recordings, visit the AHIMA Store.
Chantal Worzala is principal at Alazro Consulting. An experienced policy expert, she helps provider organizations, associations, technology companies and patient advocates navigate health policy as they transform health and healthcare using digital health tools.