Information Blocking Rule EHI Update: How LTPAC Organizations Can Prepare

Another key date related to the 21^st Century Cures Act Information Blocking Rule is fast approaching. On October 6, 2022, the definition of electronic health information (EHI) expanded to include all of the digital components of an organization’s designated record set (DRS). Prior to this date the definition of EHI was limited to the data elements represented in the United States Core Data for Interoperability (USCDI) v1.

What steps can long-term and post-acute care (LTPAC) organizations take to prepare to meet this expanded definition of EHI and comply with the Information Blocking Rule?

Information Requests from Patients

Patients may request access to their records in a timely manner (10 or less days, depending on the type of post-acute site), in a format that they prefer, or sent to an application designated by the patient, such as Google Health. Under the 21^st Century Cures Act, an organization must also be prepared to deliver the electronic components of the designated record set in paper or on a flash drive or CD. The Information Blocking Rule includes a provision requiring that patients, or their representatives, can electronically access all of their electronic health information (EHI), structured and/or unstructured, at no cost.

As of October 6, 2022, the EHI definition expands to all ePHI in the DSR. The designated record set includes any documentation (including images, wave files, etc.) that contains protected health information that was used in the care of the patient and the billing of the account. 

Now is the time to:

• Review all policies and processes associated with requests for information,
• Review or define the designated record set,
• Determine if your organization will be able to respond to patient requests to share their records a format requested (e.g. flash drive, CD),
• Assess how much of the designated record set will be available to patients through the patient portal, and
• Consider how patient data can be transmitted to and from mobile health monitoring applications.

Information Sharing with other Providers

The 21st Century Cures Act prohibits any hurdles to sharing electronic data between providers. The initiative promotes interoperability between electronic health records and encourages reporting any apparent intentional hurdles to restrict the sharing of data. The 21^st Century Cures Act is expecting providers to understand (“know or should know”) what interferes with EHR access, EHI exchange or EHI use. When thinking of exchanging EHI, keep in mind that a home health entity, hospice, and skilled nursing facility may participate in a HIN in order to share EHI between acute care and post-acute entities.  

Additionally, providers need to determine if their EHRs can exchange information. Application Programming Interfaces (APIs) are tools for two or more computer programs to communicate with each other. Fast Healthcare Interoperability Resources (FHIR) is a standard describing data formats and elements, and an API for exchanging electronic health records. In the Information Blocking Rule, the use of the HL7® FHIR® (FHIR release 4) standard, along with a set of implementation specifications is defined.

Finally, the Information Blocking Rule requires health IT developers to support API-enabled services for data on any number of patients.

Now is the time for you to assess whether your EHR is able to:

• Receive electronic information from other providers that support your patients or refer patients to you,
• Send electronic information to other providers which may be caring for your patients and/or sharing information about your patients, and
• Exchange information with other systems or applications that are used by the patient.

Time Is Short

LTPAC organizations should not delay in determining how they are going to respond to requests for information and meet the expanded definition of EHI under the Information Blocking Rule. They are expected to not interfere (i.e. engage in information blocking) with the access, exchange, or use of electronic health information (EHI), except as required by law or specified in an information blocking exception. More information is available on the ONC website and in a previous paper developed by the HIMSS LTPAC Committee, Understanding the Information Blocking Rule and Its Application in Skilled Nursing Facilities.