Information Blocking Essentials
On April 5, 2021, new Information Blocking Rules are subject to take effect. Outpatient rehab providers (including PT/OT, and SLP therapists) are subject to these rules.
This article outlines the requirements of the rules, directs you to resources to learn more, and discusses future plans to make compliance with Information Blocking Rules easier for all TheraOffice users.
The article is based on a March 31, 2021 webinar hosted by TheraOffice CEO, Dan Morrill, PT, DPT and TheraOffice Customer Success Manager, Hope Slowik.
Please note: This article is intended merely for reference and education. It does not constitute legal advice.
Applies To
Information Blocking Rules set to take effect on April 5, 2021.
All information in the article is current as of April 1, 2021.
Key Points
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Information Blocking Rules take effect April 5, 2021. You as a provider are in scope of the information blocking rules. This means, at the request of patients or physicians, you will be required to share USCDI data with the appropriate parties.
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There are 8 exceptions to these rules which your clinic should be aware of and consciously consider. You may also want to evaluate your current HIPAA procedures and re-familiarize your staff with those requirements to ensure you are always in compliance even with the new information blocking rules taking effect.
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TheraOffice is a not a CEHRT IT developer, and you are not required to purchase a CEHRT IT EMR at this time. However, we have some plans in place to help make compliance easy. In the meantime, if you receive a request for data, please contact TheraOffice Support and we will try to assist you.
Definitions to Know
Information Blocking: Information Blocking is a practice by an actor that, except as required by law or specified by the Secretary of Health and Human Services (HHS) as a reasonable and necessary activity, is likely to interfere with access, exchange, or use of Electronic Health Information (EHI).
Actors: Actors, as defined by information blocking rules include: providers, Health IT Developers of Certified Health IT (please note: TheraOffice is NOT a certified product), Health Information Exchanges (HIE), and Health Information Networks (HIM).
EHI: Electronic Health Information (EHI), under the Interim Final Rule, is currently limited to the USCDI standard for Information Blocking purposes.
USCDI: The United States Core Data for Interoperability (USCDI) is a standardized set of health data classes and constituent data elements nationwide, interoperable health information exchange.
Interoperability:
Direct Messaging:Direct messaging is a secure means of sharing health information via healthcare providers. Direct messaging does, however, require information to be formatted in a CDA format.
CDA: Clinical Documentation Architecture (CDA) is a standardized format for information which breaks up health information into individual elements. This ensures only the minimum necessary information is transmitted, as well as makes it readable for other CDA enabled Health Systems, thereby allowing greater data transmission and compatibility.
Timelines
- Interim final rule that was delayed from November 2, 2020 until April 5, 2021 in response to the COVID Pandemic.
- There has been a strong push to delay further for security reasons and COVID recovery efforts.
- As of today, April 1, 2021 there has been no communication for another delay.
- Full implementation of the USCDI v 2 is scheduled to be October 6, 2022.
USCDI (United States Core Data for Interoperability)
For the first round of information blocking rules, set to take effect on April 5, 2021, only limited data is required to be shared. This includes:
- Allergies and Intolerances
- Assessment and Plan of Treatment
- Care Team Members
- Clinical Notes
- Goals
- Health Concerns
- Immunization
- Laboratory reports
- Patient demographics
- Problems
- Procedures
- Provenance (History, Author of data)
- Smoking Status
- Unique ID for implantable devices
- Vitals signs
- Medications
USCDI v2 is currently in draft status and is currently set to be implemented in October 2022. We will keep everyone apprised of these changes.
The 8 Exceptions to the Rule
There are 8 exceptions to information blocking, wherein the information is not subject to blocking rules. Your clinic should be intimately familiar with these exceptions, which include:
- Preventing Harm Exception
- Privacy Exception
- Security Exception
- Infeasibility Exception
- Health IT Performance Exception
- Content and Manner Exception
- Fees Exception
- Licensing Exception
Details on each of these exceptions are available via The Office of the National Coordinator for Health Information Technology here.
Hands on Technology firmly recommends clinics become familiar with all exceptions and particularly the Content and Manner Exception, which is directly applicable to TheraOffice users at this time.
Direct Messaging
Direct Messaging does not make you immediately compliant for information blocking rules, however, it is a secure conduit to communicate with other healthcare providers. So, it can be a step in the right direction to allowing information to flow freely.
The above image is a sample of direct messaging. You can see the information is sent to a direct address and the relevantinformation is selected.
In essence, direct messaging works similarly to an email. You sign up for direct messaging via a 3rd party direct messaging platform, such as EMR Direct. They will verify your identity through the application process to ensure you have the credentials to send and receive health information. You will then receive a unique Direct Address--some clinics choose to use a single organization address while others may want individuals to have their own, this is a business decision made by your organization. Once you have an address, you build a trusted network of other providers to share information via direct messaging. Information is sent via CDA (Clinical Documentation Architecture) guidelines, which essentials breaks up information into the minimum necessary to ensure only relevant information is transmitted and puts it into a format which is readable to other Health Systems.
Direct Messaging has the distinct benefits of 1) helping to make information accessible to providers who need it, thereby satisfying information blocking rules when used properly and, 2) increasing the ease of referrals. You may receive more referrals from physicians when it is easier for them to do so.
The Future of TheraOffice and Information Blocking
Is TheraOffice required to comply with Information Blocking rules?No, TheraOffice is not in scope for the information blocking rules, as we are NOT a developer of Certified EHRT.
Why isn't TheraOffice a Certified Health IT product?The short answer here is simply that TheraOffice has never needed to be: certification is a long and expensive process. Having a certification for our product has never been meaningful for our users and we don't want to pass the expense of a certification on to users without you receiving any significant, impactful benefits. Rest assured, however, that if Outpatient Rehab is ever given a clear path to become certified in a meaningful way for our profession, we will move forward and certify as soon as possible. We watch these regulations closely to ensure you are always in compliance and that TheraOffice is able to meet the needs of our users effectively and affordably.
The future roadmap:
Short term:In the short term, HOT is currently developing a method to create CDA (Clinical Data Architecture) with the data that is currently in TheraOffice. When complete, this will be able to create a report in a format that can be digested and translated into another healthcare system via Direct Messaging. Talks have begun to integrate with 3rd party direct messaging systems which could then deliver that CDA data to the requestor of information.
We have also started internal development on patient portal improvements which would give you the power to upload patient records into the portal. We expect these improvements to release this year.
Long term: The long term goal is for TheraOffice to achieve interoperability. HOT has laid out a plan for TheraOffice to have a full FHIR (Fast Healthcare Interoperability Resources) API endpoint to handle EHI requests. We expect this to be completed prior to the USCDI v2 deadline in October 2022.