Netsmart CareThreads
Netsmart CareThreads

Episode · 8 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.


If you want to hear more episodes like this one, check us out on Apple Podcasts.


If you don't use Apple Podcasts, you can find every episode here.

Welcomed in that smart care, threads, apodcast for Human Services and postocute leaders across the healthcarecontinuum come together to discuss industry trends, challenges andopportunities. Listen is we uncover real stories about how to innovate andimprove the quality of Care Tor the communities we serve? Let's get intothe show hello and welcome to this podcast fron information blocking I'dCarol, Reynolds, I'm an executive strategist here at not smart, and Ihave with me today: NUTSMART's regulatory strategist, Sherry Walen,Sherry. Why don't you kick off the Webenar and start to tell us a littlebit about? Well, what is information blocking and what aspects of it takeeffect now or pretty soon and what take effect later and what we have to sharethanks Carol, I appreciate you, you asking me to join you here, so hieveryone I just want to go over really quickly about information blocking andit's what we're calling or what's being referred to is the ONC final rule forthe cures act. This final rule that came out last year in two thousand andtwenty really goes over information blocking, as well as certifficationrequirements, the thousandand fifteen certification requirements. These aretwo distinct hearts within the rule, and I know there might have been someconfusion before about how these pieces work with each other and while they'rerelated, they do work independently of each other, and I'm going to talk aboutthat here in just a moment. But let me talk about first, just informationblocking in itself and what we're looking at there if you're familiar theinformation blocking, is really trying to open up avenues of data sharingacross all platforms. This was a request that came out of Congress toONC to really start defining what the...

...problems were and what the hold upswere in getting that data moving across the platforms and one of theindications was that there was information blocking happening eitheron purpose or not, and how we can start moving that data forward. So so thisrule really is trying to get to the heart of that and what Congress islooking for, so for information blocking for just that part of the rule,O NC defined the actors. If you're a provider, you are an after certifiedsolution. Providers are an actor and your health information networks areactors, but we have we've seen a an additional time to start complying withthis. The first date now is April, fifth of two thousand and twenty one tocomply with the elements of information blocking now. This is just the firsthurdle and what this hardle includes is being able to provide inioperable datain the US CDI or the US cor data elements for inropprability version.One ONC has defined that as the dataelements that would be used in ineroperability between AprilFifth, two thousand and twenty one and October Fifh, two thousand and twentytwo after that date, which would be Octobersix two thousand andtwenty two ONC, expects that all EHI informationunder the Hippi definition of electronic health information would beinteroperable. So that's the second hurdle that we'll have to get throughright 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 up to a much morebroad spectrum of data that they are looking to make iniroperable now theone o. One thing I want to point out is there's another section of this: notjust compliance but also enforcement.

So the Office of the Inspector Generalis under the enforcement aspect of information blocking and as of Midmarch.They have not released a final rule on any kind of civil money penalties. Sowe, even though we are coming up on acompliant state of April Fih, there is no information blocking civil moneypenalties until there is a final rule from the office office of InspectorGeneral, the OIG, as well as an implementation date from them. Once we get that final rule, there isnot a there will not be a retroactive or retrospective enforcement ofpenalties. It would only be from the point that the OI g enforces this andmoves forrward. So it's somewhat of a grace period and and ONC has recognizedthis and actually called that out. As a period of time where the industry canreally continue to work on their solutions as an industry to make thisdata interoperable now I want to to talk for just a moment about the twothousand and fifteen certification that I mentioned earlier. This was also anelement of the ONC final rule on cures, but it's not a requirement forinformation, blockings, two distinct parts of the final rule and they, like,I said, they're, very independent of each other. So if you have a certifiedsolution, there are requirements that will be updated that are required byDecember thirty. First, two thousand and twenty two so you'll see somechanges for your certified solution for that aspect of the rule. But if you'renot on a certified solution, then that two thousand and fifteen certificationportion of the rule doesn't apply to you now. Let me talk for a moment about theUSCDI data elements. So again, these are data elements that have beendefined by the industry. This has already gone through a vetting processthrough the ONC in previous rulemaking...

...and they've. Just used this as thatcommon Dataset Minimum Dataset that they're looking for to start movingthat data and making it interoperable now I do want to point out that again,if you're not on a certified solution, there's really not a requirement to usethe standard designated Dataset for each element. What that means is, ifyou have a data element that may be defined in the US CDI certifiedsolution for a loint code to use a very spes specific loi code, H T it's not arequirement for a noncertified solution, they're, really just trying to get thatdata into an interoperable state and getting it moving forward. So wit. Thatsaid, some of the elements they've defined they've brought them intodifferent category. So I'm going to run through some of those really quicklywe're looking at allergies and intolerances, which include substancesor the drug class and medication, and those reactions, assessment and PLANEFtreatment. Your Cara Team members clinical notes, which includeconsultation, notes, discharge, summary Notes, history and physicals, imagingnarratives laboratory report, narratives, pathology report,narratives procedure, notes, progress, nodes, patient goals, health concerns,immunizations lab tests and values and results medications all of the patientdemographics, including birth sex, ethnicity, race and preferred languageproblems, defined procedures and provinance, which is the author timestamp and author organization on the data elements which is important whenYouare importing an exporting data that came from either internal to yoursolution or external into your solution and then smoking status, unique device,identifiers for implinable devices and...

...then vital sign such as your bloodpressure body, height weight, heart rate, respiratory Phole, socx BMIS,wait for length percentel from birth to thirty six months and head for exipitle,feneral circumference, so the the head. So those just a quick review. But Iwant to point out that there are probably elements here that you'rethinking I don't have that. Nor do I collect it and that's okay! You don'thave to go out and start collecting that information. If that's not part ofwhat you currently have available to you or is a part ofyour workflow, for example, in the postaqt care perspective, there may besome pediatrics, but that's not something that most of thepostecutecare providers really have available to them. So they wouldn'thave the the wait in length percentile and the the head circumference at birthand all of those elements. So by not having those data elements, it does notmake you an information blocker, because it's not information you couldprovide. You don't have to start collecting data that isn't specific towhat you already have available to you. There are some additional needs aroundclinical notes and I'm going to turn it over to Carol to talk about that. Well,thank you, Sherry. I can take the clonical notes. Parrat. I think that'sa paradime shift for everyone to start thinking o the comical record is beingowned by the individual and I think that's one of the major things thatinformation wocking was trying to get at and thus clinical notewas coming toview. They're new to the data exchange. We've been working with certificationsfor a long time. These have not been required in any previous certifications.The definition is fairly comprehensive that they gave us on clonical notesstating that they can be composed of both structured in thanstructure data.So structure data would be things like...

...drop down. Lister, picklest, check,faxes and unstructured data. That's what we all know best and that's justwriting in a textbox or free text. A clinical note may include a lot ofdifferent things at history or review of systems. Physical data assessmentdata treatment plan data, even paypatient teaching data could beincluded as part of the clinical notes. The rule specifically calls out, as inall of these as inclusive consultation, notes, discharge, summaries, historyand physicals laboratory, narratives procedure, notes and progress notes,but there are a few exclusions that are really important to take intoconsideration of the first of these that I'll talk about is psychotherapynotes. So if you have the psychitrints that right psychotherapy notes withinyour system, you can go to se Afr forty five part unred an sixty four and readthe definition of a psychotherapy. Note, that's the one that we're basing thisconversation on, but it's a note recorded in any medium by a healthcareprovider, who's a mental health, professional document or analyzing. Thecontents of the conversatation during a counseling session, so you'll need towork with your HR dender. If you do psychotherapy note on how you can flagthem so that they don't have to be included when you're sharinginformation as part of the information blocking- and I think the secondimportant consideration here is- there- is a preventing harm exception.Allowing you to not share notes at you, have a siggnificant reason to believethat not sharing the notes will prevent harm. So this exception recognizes thatthe public interest is there and protecting patients and other personsagainst unreasonable risks of harm, and that that...

...trumps, the information blacking or theinformation sharing part of this. That, if you feel that, there's a reason thatharm would be caused that you could not share that information. But you have tohold that as a reasonable beliek and they recommend strongly that thoug.Your practice should be consistent with. However, you decide not to share thatinformation 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 theother exceptions, Center Round, privacy, security and feasibility and even hitperformance. This all flows into one area ofcompliance that can easily be overlooked when you're working towardsinformation blocking, and that is trading, an education, ther, really twoareas of training and education to think about here, one for yourassociates and one for the consumer so for associates. This is, isn't all new.It shouldn't not be new, because they've had to deal with HIPP orequests for some time. But what is new? There's a lot of terminology a lot ofacronyms, I know Sherry, said a number of times US CDI, the United States,core data for introp Rability, most of the time your socials an't going toknow what 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 likedefinitions of clinical notes. They might not understand that and, veryimportantly, they might not understand your policy how you going to do it. Howare you going to share this information? Where are you going to report therequest that are coming in for data Sharry for? Are you going to recordwhat you shared with those people and what you didn't share? All of thatneeds process and procedure wrapped...

...around it, and that filters on a lot ofthe education that you need to provide those individuals but there'ssimilarities to what you've already done and taught people on the health,insurance, portability and Accountability Act? But now, let's discuss the consumer,this isn't no to the consumer either they could have deahippa requestedcopies of their their health information historically, but many ofthem didn't request it. The primary difference between Hita and informationblocking is the information you share needs to be provided in a machine,readable format. Sharing data electronically is the new part. So manyorganizations are thinking about enhancing the patient experience byhelping educate patients about the privacy and security of healthinformation, the importance of keeping that information confidential and notsharing it and not being loose with that information that was recommendedby OMC as a step that organizations might want to take as that proactiveeducation to consumers, but saficat many organizations are shifting to whatI call proactive education. So, for example, many health care providerstoday delay the release of lab results in an attempt to protect patients frommisinterpreting those results or learning about potentially lifealtering results without guidance afd perspective from their practitioner. Iknow that's what my practitioner does is. I don't have the ability to seethose lab results until I have a conversation with that practitioner.Well, that could now be construed as information, blockmocky and one waysome organizations ake getting around. That is when they go to do a lab test.Have the conversation with me before I would have an opportunity to see theresult. Kee Carrol, with this test,...

...there's two possible oncoms one wouldbe negative, in which case we're going to continue with the group therapysessions that you're in right now for another two months and if the result ispositive, wer going to supplement what we're already doing with a newmedication. So if it's positive, I'm not have a phone conversation with youand prescribe the medication and we'll just try for ninety days and then we'llprobably do a retest document that education document that conversation-it's it's a good parter to have or good to have that as part of the consumerschart. We've discussed today a lot of internal policy changes that you shouldbe considering as part of the information blacking. This shouldcompliment your hippopolicy and practice policies about sharing yourpatient's data reminder sharing. The date is what tApril April Fifh two thousand and twenty one is the beginning of thecompliance period. So with this plan O and ses ultimate goal is a universalhealth record to spark better care to spark better care coordination andultimately increase patient outcoms information. blacking is another giantstuff towards meeting that goal, but it requires some internal changing a lotof internal policy documentation and a bunch of training. I hope that you got some good greatinformation about this. We have this information blocking series and lookforward to providing you the next one in the series. Thanks for joining.Thank you at that. SMART. We understand the challenges facing providerorganizations. Our team will help you navigate changing value, based caremodels with solutions and services that make person centered care or realitywill equip you with technology and services that provide holistic, realtime. Views of Care Histories that...

...inform better decision making andbetter outcomes visit us today at ntstcom Netsmart serving you. So youcan serve others thanks for listening to the Netsmart Care, threads podcastthrough collaboration and conversation, we can work together to make healthcaremore connected than ever before and better support the communities we serveto ensure you never miss an episode. Please subscribe to the show in yourfavorite podcast player, if you use apple, podcast, we'd love for you togive us a quick rating for the show just cap. Tae Number of stars that youthink the podcast deserves until next time.

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