Interoperability and Patient Access Final Rule: What to Know

By Devin Partida, Editor-in-Chief,
Twitter: @rehackmagazine

As of May 10, 2020, IT specialists working in health care had to begin investigating how to implement requirements related to the Centers for Medicare & Medicaid Services (CMS) Interoperability and Patient Access final rule.

They have until 2022 to get it done, although specific deadlines apply for particular milestones. Here’s a look at what the Interoperability and Patient Access final rule means for facilities, patients, and providers.

What Are the Goals of the Interoperability and Patient Access Final Rule?

The Interoperability and Patient Access final rule aims to let patients exercise more ownership of and accountability for a larger but consolidated set of their electronic health information. Moreover, they can give consent for having that content shared with providers and companies that offer health plans.

Part of the effort involves creating a network of regional data brokers arbitrating how information flows from patients to approved parties after consent occurs. A tier-based system will also dictate how patients authorize information sharing, whether by opting in or out.

Relatedly, federally certified IT professionals will have access to the same patient details that medical providers do. However, they’ll use those privileges to create digital tools that streamline the user experience.

How Can Applicable Parties Get Reliable Guidance About the Final Rule?

Government authorities published a 17-page FAQ document outlining some of the scenarios medical professionals may encounter while complying with this final rule. There’s also a shorter fact sheet outlining some of the main changes and requirements.

For example, as of May 1, 2021, a stipulation came into effect about admission, discharge, and transfer (ADT) notifications that applies to all hospitals, including psychiatric and critical access facilities.

The new rule requires all such organizations to have the ability to send notifications to the relevant parties. For example, if a person calls an ambulance due to sudden chest pains and the hospital admits them, the patient’s primary care physician would get an alert about that decision.

How Will the Final Rule Change Data Sharing?

Even a relatively healthy person typically amasses a substantial amount of medical data during their lifetimes. Moreover, statistics show that nurses spend a quarter of their workdays on documentation. Fortunately, technologies like artificial intelligence (AI) can reduce that percentage. This CMS final rule could bring positive effects of its own — such as reducing the barriers that keep patients from their health data.

For example, a part of the final rule requires providers to link electronic health records to third-party apps. Then, patients can access that data via applications that they may already know and love, eliminating the learning curve associated with using an unfamiliar method to see the data.

A similar requirement applies to Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) plans, as well as those sold on federal exchanges. Patients benefiting from those entities must have the ability to get access to digital data about their claims while using smartphones or other readily available devices, such as tablets.

However, applicable organizations must offer that ease of access while maintaining data security. As more hospitals and other relevant entities comply with the final rule, patients should notice that it’s significantly easier than before to access their health information.

Now Is the Time to Act

The Interoperability and Patient Access final rule requires substantial changes to data access and sharing. People working at facilities that must abide by the new specifics must not wait too long to build or improve the framework that will enable them to meet the stated deadlines.

Individuals at certain facilities — such as rural hospitals — may have a higher-than-average number of challenges while planning for these technological improvements. However, anticipating and managing those obstacles promptly will help those upgrades go more smoothly and aid proactive decision-making.