Netsmart CareThreads
Netsmart CareThreads

Episode · 10 months ago

Information Blocking: What you need to know now


Information blocking is all about the data – access to, exchange of, and use of electronic health information (EHI) – regardless of what technology is used. Most importantly, information blocking directly impacts your organization.

The Office of the National Coordinator for Health Information Technology (ONC) published a Final Rule in May 202, in the 21st Century Cures Act that sets requirements related to Information Blocking. These new regulations that will significantly impact how providers like you manage consumer health information.

Listen in to hear Netsmart senior vice president, Carol Reynolds and Netsmart regulatory strategist, Cheri Whalen, discuss what information blocking and the final rule mean for your organization and what you can do now to prepare for the April 5, 2021 compliance date.

Key topics discussed:

- Strategies to improve response times for data exchange

- How to educate your consumers about accessing their data

- Tips for breaking down USCDI data elements for your staff and consumers

This discussion with Carol Reynolds and Cheri Whalen was taken from our show Netsmart CareThreads.


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Welcome to net smart care threads,a podcast where human services and post acute leaders across the healthcare continuum come togetherto discuss industry trends, challenges and opportunities. Listen is we uncover real stories abouthow to innovate and improve the quality of care for the communities we serve. Let's get into the show. Hello and welcome to this podcast and informationblocking. I'm Carol Reynolds. I'm an executive strategist here at that smart andI have with me today that smarts regulatory strategist, shrry. Whilon. Sherry, why don't you kick off the Webinar and start to tell us a littlebit about well, what is information blocking and what aspects of it take effectnow or pretty soon and what take effect later and what we have to share. Thanks, Carol. I appreciate you you asking me to join you here. So Hi everyone. I just want to go over really quickly about informationblocking and it's what we're calling, or what's being referred to, is theONC final rule for the cures act. This final rule that came out lastyear in two thousand and twenty really goes over information blocking as well as certificationrequirements the two thousand and fifteen certification requirements. These are two distinct parts within therule and I know there might have been some confusion before about how thesepieces work with each other and while they're related, they do work independently ofeach other and I'm going to talk about that here in just a moment.But let me talk about first just information blocking in itself and what we're lookingat there. If you're familiar, the information blocking is really trying to openup avenues of data sharing across all platforms. This was a request that came outof Congress to OH ANDC to really start definding what the problems were andwhat the hold ups were in getting that... moving across the platforms, andone of the indications was that there was information blocking happening, either on purposeor not, and how we can start moving that data forward. So sothis rule really is trying to get to the heart of that and what Congressis looking for. So for information blocking. For just that part of the rule, OHENC defined the actors. If you're a provider, you are anactor. Certified Solution providers are an actor and your health information networks are actors. But we have we've seen a an additional time to start complying with this. The first date now is April five of two thousand and twenty one,to comply with the elements of information blocking. Now this is just the first hurtleand what this hurtle includes is being able to provide interoperable data in theUS CDI or the US core data elements for interoperability version one. Owen Chas defined that as the data elements that would be used in interoperability between Aprilfive two thousand and twenty one and October five two thousand and twenty two.After that date, which would be October six two thousand and twenty two,Owenc expects that all EHI information under the HIPPA definition of electronic health information wouldbe interoperable. So that's the second hurdle that will have to get through.Right now we're trying to get to a subset of interoperable data, which I'lltalk to in a moment, and then after that it really opens it upto a much more broad spectrum of data that they are looking to make interoperable. Now the one one thing I want to point out is there's another sectionof this, not just compliance but also...

...enforcement. So the Office of theInspector General is under the enforcement aspect of information blocking and as of mid Marchthey have not released a final rule on any kind of civil money penalties.So we even though we are coming up on a compliance date of April five, there is no information blocking civil money penalties until there is a final rulefrom the office office of Inspector General, the OIG, as well as animplementation date from them. Once we get that final rule, there is nota there will not be a retroactive or a retrospective enforcement of penalties. Itwould only be from the point that the OIG enforces this and moves forward.So it's somewhat of a grace period, and and ONC has recognized this andactually called that out as a period of time where the industry can really continueto work on their solutions as an industry to make this data interoperable. NowI want to talk for just a moment about the two thousand and fifteen certificationthat I mentioned earlier. This was also an element of the OWNC final ruleon cures, but it's not a requirement for information blockings. Two distinct partsof the final rule and they, like I said, they're very independent ofeach other. So if you have a certified solution, there are requirements thatwill be updated that are required by December thirty one, two thousand and twentytwo. So you'll see some changes for your certified solution for that aspect ofthe rule, but if you're not on a certified solution, then that twothousand and fifteen certification poor of the rule doesn't apply to you. Now letme talk for a moment about the USCDI data elements. So again, theseare data elements that have been defined by the industry. This is already gonethrough a vetting process through the ONC in...

...previous rule making and they've just usethis as that common data set, minimum data set that they're looking for tostart moving that data and making it interoperable. Now I do want to point outthat again, if you're not on a certified solution, there's really nota requirement to use the standard designated data set for each element. What thatmeans is if you have a data element that may be defined in the USCDIcertified solution for a loint code, to use a very special specific point code, that it's not a requirement for a non certified solution they're really just tryingto get that data into an interoperable state and getting it moving forward. So, with that said, some of the elements they've defined, they've brought theminto different categories, so I'm going to run through some of those really quickly. We're looking at allergies and intolerances, which include substances or the drug classand medication and those reactions. Assessment and plan a treatment, your care teammembers, clinical notes, which include consultation notes, dis summary Notes, historyand physicals, imaging narratives, laboratory report narratives, pathology report narratives, procedurenotes, progress notes, patient goals, health concerns, immunizations, lab testand values and results, medications, all of the patient demographics, including birth, sex, ethnicity, race and preferred language, problems, defined procedures andprovenance, which is the author time stamp and author organization on the data elements, which is important when you're importing and exporting data that came from either internalto your solution or external into your solution, and then smoking status, unique deviceidentifiers for implantable devices and then vital...

...signs such as your blood pressure,body height, weight, heart rate, respiratory whole socks BMI's weight for lengthpercentile from birth to thirty six months and head for accipital frontal circumference, sothe the head. So those just a quick review. But I want topoint out that there are probably elements here that you're thinking I don't have that, nor do I collect it, and that's okay. You don't have togo out and start collecting that information if that's not part of what you currentlyhave available to you or is a part of your workflow. For example,in the Post Acute Care Perspective there may be some pediatrics, but that's notsomething that most of the post acute care providers really have available to them.So they wouldn't have the the weight and length percentile and the head circumference atbirth and all of those elements. So by not having those data elements,it does not make you an information blocker because it's not information you could provide. You don't have to start collecting data that isn't specific to what you alreadyhave available to you. There are some additional needs around clinical notes and I'mgoing to turn it over to Carol to talk about that. Well, thankyou, Cherry. I can take the clinical notes Parad I think that's aparadigm shift for everyone to start thinking of. The clinical record is being owned bythe individual, and I think that's one of the major things that informationblocking was trying to get at. And thus clinical notes come into view.Their new to the data exchange. We've been working with certifications for a longtime. These have not been required in any previous certifications. The definition isfairly comprehensive that they gave us on clinical notes, stating that they can becomposed of both structured and manstructured data. So structured data would be things likedrop down lists or pick list check boxes,...

...and unstructured data, that's what weall know best, and that's just writing in a textbox or free text. A clinical note may include a lot of different things. That history orreview of systems, physical data, assessment data, treatment plan data, evenpatient teaching data could be included as part of the clinical notes. The rulespecifically calls out, as in all of these as inclusive consultation notes, discharge, some reason, history and physicals, laboratory narratives, procedure notes and progressnotes. But there are a few exclusions that are really important to take intoconsideration. The first of these that I'll talk about the psychotherapy notes. Soif you have a psychiatrist that write psychotherapy notes within your system, you cango to sefr forty five, part one hundred and sixty four and read thedefinition of a psychotherapy note. That's the one that we're basing this conversation on, but it's a note recorded in any medium by a healthcare provider WHO's amental health professional, documenting or analyzing the contents of a conversation during a counselingsession. So you'll need to work with your HR vendor, if you dopsychotherapy note, on how you can flag them so that they don't have tobe included when you're sharing information. Is Part of the information blocking and Ithink the second important consideration here is there is a preventing harm exception allowing youto not share notes if you have a significant reason to believe that not sharingthe notes will prevent harm. So this exception recognizes that the public interest isthere in protecting patients and other persons against unreasonable risks of harm and that thattrump's the information flocking or the information sharing...

...part of this that if you feelthat there's a reason that harm would be caused, that you could not sharethat information, but you have to hold that as a reasonable belief and theyrecommend strongly that the your practice should be consistent with however, you decide notto share that information and document that in your organizational policy. There's a fewother exceptions that come into play, but the two we just talked about werepretty major ones that could apply to many different organizations. But the other exceptionscenter around Privacy, security, in feasibility and even hi t performance. Thisall flows into one area of compliance that can easily be overlooked when you're workingtowards information blocking, and that is training and education. There are really twoareas of training and education to think about here, one for your associates andone for the consumer. So for associates this is isn't all new. Itshouldn't all be new because they've had to deal with HIPPA requests for some time. But what is new is a lot of terminology, a lot of acronyms. I Know Sherry said a number of times USCDI, the United States coredata for interoperability. Most of the time you're a social sign going to knowwhat that means when you say it, and they probably don't have to acceptfor that there's clear definitions of what that data should look like, definitions ofclinical notes. They might not understand that and, very importantly, they mightnot understand your policy. How you going to do it? How are yougoing to share this information? Where are you going to record the requests thatare coming in for data share, for are you going to record what youshared with those people and what you didn't share? All of that needs processand procedure wrapped around it, and that...

...filters on a lot of the educationthat you need to provide those individuals. But there's similarities to what you've alreadydone and taught people on the Health Insurance portability and Accountability Act. But nowlet's discuss the consumer. This isn't new to the consumer either. They couldhave be a hip up requested copies of their their health and formation historically,but many of them didn't request it. The primary difference between HIPPA and informationblocking is the information you share needs to be provided in a machine readable format. Sharing data electronically is the new part. So many organizations are thinking about enhancingthe patient experience by helping educate patients about the privacy and security of healthinformation, the importance of keeping that information confidential and not sharing it and notbeing loose with that information. That was recommended by Ollenc as a step thatorganizations might want to take, as that proactive education to consumers. But Sadat many organizations are shifting to what I call proactive education. So, forexample, many healthcare providers today delay the release of lab results in an attemptto protect patients from misinterpreting those results. Are Learning about potentially life altering resultswithout guidance and perspective from their practitioner. I know that's what my practitioner does. Is I don't have the ability to see those lab results until I havea conversation with that practitioner. Well, that could now be construed as informationblocking and one way some organizations are getting around that is when they go todo a lab test, have the conversation with me before I would have anopportunity to see the results. A Carol,...

...with this test, there's two possiblelocomes. One would be negative, in which case we're going to continuewith the group therapy sessions that you're in right now for another two months andif the result is positive, we're going to supplement what we're already doing witha new medication. So if it's positive, I'm not have a phone conversation withyou and prescribe the medication and we'll just try for ninety days and thenwe'll probably do a retest. Document, that education document, that conversation.It's a it's a good part to have or good to have that as partof the consumers chart. We've discussed today a lot of internal policy changes thatyou should be considering as part of information blocking. This should compliment your hip, hop, policy and practice policies about sharing your patients data. The remindersharing the date is what April? April five two thousand and twenty one isthe beginning of the compliance period. So with this plan, Owen sees ultimategoal is a universal health record to spark better care, to spark better carecoordination and ultimately increase patient outcomes. And rasion blocking is another giant stuff towardsmeeting that goal, but it requires some internal changing, a lot of internalpolicy documentation and a bunch of training. I hope that you got some good, great information about this. We have this information blocking series and look forwardto providing you the next one in the series. Thanks for joining. Thankyou. That net smart. We understand the challenges facing provider organizations. Ourteam will help you navigate changing value based care models with solutions and services thatmake person centered care a reality. Will equip you with technology and services thatprovide holistic, real time views of care...

...histories that inform better decisionmaking and betteroutcomes. visit us today at intstcom. Net smart serving you so you canserve others. Thanks for listening to the net smart care threads podcast. Throughcollaboration and conversation, we can work together to make healthcare more connected than everbefore and better support the communities we serve. To ensure you never miss an episode, please subscribe to the show in your favorite podcast player, if youuse apple podcast. We'd love for you to give us a quick rating forthe show. Just have the number of stars that you think the podcast deserves. Until next time,.

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