Home Forums Discussions General Discussion Information Blocking

Any thoughts about the new "Information Blocking" law going into effect nationwide on April 5, 2021? Specific relevance to use of AC? I just heard about it today, because, apparently, I live in a cave.... Most information sources I have come across are replete with jargon and legal prose, and not directed at physician office practice with practical guide to implementation.

Looks like what the law is about is to increase the possibility of medical information transferability between EHRs
In principle that should be a good thing.
Lets see how it can be twisted to someone's (other than the patient or their physician's) benefit.

Information Blocking has been a part of MIPS for a few years now. It is a little hard to understand, as CMS tends to like it's "Legal Speak", but in essence its not that hard. What is basically says is that the practice will not knowingly restrict functionality that allows them to complete measures for MIPS. An example is a practice refusing to give out their direct address to other practices. This would prevent them from receiving a transfer of care, and therefore they can take the exclusion. That is a basic example of information blocking.

This will expand a bit with the new Cures Act that is going into place. With that piece of legislation, EHR's (including AC) will need to send the patient's medical record to the device of the patient's choice. This will be accomplished through the use of open API's. In this case, if the patient requests it, the practice would need to do it. Failure to do so would be considered information blocking. Of course there will be technical limitations (the device has to be able to accept the information... the patient can't say "send my information to my 1990 Nokia phone"). BTW, AC can already do API calls, and has for a while now. The documentation can be found here: https://amazingcharts.com/api-documentation/

That is the simplified version of this. Like with any law, there are a bunch of exceptions, loop holes, and technical jargon to work through. Healthit.gov is fairly readable and does a good job summarizing to the best of their ability. Here is the link: https://www.healthit.gov/curesrule/final-rule-policy/information-blocking

I hope this helps a little. Let me know if you have any questions.

Thanks for the clarification, Mark.
I'm pretty sure that doctors and patients want important information to be freely transferrable, because patients have to constantly be changing doctors and hospitals as the insurance contracts change.

I am also pretty sure that despite lip service paid to that goal by hospitals, insurance companies and EHR vendors, that their best interest is served by forming impenetrable silos and fighting like hell for market share - patients and doctors be damned.

My eyes just glaze over, and I get a hollow, crawly feeling in my gut when I read about it.
I just can't stand what a total disaster the American medical "system" is becoming.

New legislation goes into effect on April 5, 2021. The legislation states that patients are entitled to basically their entire medical record, including progress notes (in an outpatient), labs, radiology, etc.

None of that is especially new.

The new federal rules say that the daily progress notes are to be made available immediately. This is where we may see a change that is somewhat concerning.

Two potential issues: we must now be prepared to provide this data - immediately - as per the statute.

In addition, many hospitals that have patient portals have begun "pushing" these results to the patients. In other words, the patient gets the results without necessarily ask for them.
This means the patient often gets the results before we do.

Be prepared for plenty of questions like "The MCHC on my CBC is low. What does that mean"? Along with discussions of every incidentaloma on every scan.

Thanks Mark for coming on the board and helping. Much appreciated. Let others know that they are always welcome and appreciated.

It is great to have AC (Mark) in on this discussion. However, the link provided for API leads to a page that includes:

This documentation is intended to provide direction for accessing patient data from the Common Clinical Data Set using the Amazing Charts Common Clinical Data API to satisfy 2015 CEHRT Regulations § 170.315(g)(7), § 170.315(g)(8), and § 170.315(g)(9).

Click here to access the API documentation. (THIS IS MOSTLY PAGES OF CODE)

Click here to request API access. (THIS LEADS TO A BLANK PAGE)

So.... Not sure how this helps us poor little Luddites. To facilitate this conversation, may I define a few relevant inquiries:

Specifically, how does this law change more traditional medical record information exchanges, where a written request is made of a provider and the information is subsequently faxed (which in my state by law allows 15 business days to be accomplished, after any applicable medical record fee is paid, barring emergency requests from physicians which are addressed ASAP without fee).
For example:
1. If a patient requests information from their record, do they still have to fill out a medical record request (per HIPAA). Will patients be in a two class system, those using the old methods and those using the new?
2. Can a medical record fee still be charged for non-emergent requests before providing the information?
3. Do we have to join to an app that allows direct patient access to their records (to some degree) at all times?
4. Does the AC/Updox portal provide the same functionality as an app would?
5. Must patients register with provider specifically for this direct access before it it provided?
6. I receive study and lab reports in PDF format and they are stored in PDF format in AC. Can I get examples of how to provide notes and reports to patients under the new law using AC?
7. I get records and reports from other providers. Do I / can I provide access to these to patients?

While some of the above might not be in the purview of AC, the AMA recommends that we ask our EHR vendor the questions that are pertaining to access implementation via the EHR.
Well, asking done!
(But Grandma, what a big onus you have!)

OK, crickets. I believe the sound I am hearing is crickets.

I emailed AC support directly about how to use AC to implement the Cures Act requirements, I'll pass along any info.

Am I making a bigger deal about this than needed? It's just that I saw articles about OIG investigations and criminal penalties, and had to cut back on my fiber intake...

Anyway, everyone have a great day!

Hi Jack..

Thanks for your questions. Sorry I didn't respond right away, but I don't check the board on a daily basis.

On the API link I put in previously, yes the document is very technical. It is really designed for IT and developers to use to make an API interface with AC. It is not something that the normal person can just look at and understand right off the bat. Think if handing your patients a medical textbook. They might have a harder time understanding that. At this time, that is all CMS requires us to do, is show that we can have an API if needed.

The link for requesting should prompt a "mailto:" command to have you email our support team. I will have our webmaster look at that to see why its not working.

As for your questions, here are some of the answers to them. I just want to make it clear that I am not part of our development team, so I am not privy to any features that are being developed. I work on the training side and assist practices with MIPS.

1. If a patient requests information from their record, do they still have to fill out a medical record request (per HIPAA). Will patients be in a two class system, those using the old methods and those using the new? I would assume yes, they would still need a HIPAA release. This should not change with how the information is delivered. (paper/electronic/whatever new technology emerges)

2. Can a medical record fee still be charged for non-emergent requests before providing the information? Fees can be charged, but they cannot be a “for profit fee”, meaning it can only be the cost involved in providing the records (employee time/materials). It has to be a reasonable fee.

3. Do we have to join to an app that allows direct patient access to their records (to some degree) at all times? At this time, no. As long as the patient can access the information from their device, that would satisfy the requirement.

4. Does the AC/Updox portal provide the same functionality as an app would? At this time, yes. Updox and the portal is a web based application and as long as they can access the via the web from their device, then that fulfills the requirement.

5. Must patients register with provider specifically for this direct access before it it provided? Unclear at this time, but I would assume if they were going to use a 3rd party app to get their health info, there will be a registration and linking process that will need to happen, similar to patient portal registration or HIE connectivity.

6. I receive study and lab reports in PDF format and they are stored in PDF format in AC. Can I get examples of how to provide notes and reports to patients under the new law using AC? You can send them now to the portal by right clicking on the item in the imported items and selecting “send to portal”. Patients can then go on the portal and get the file. The upload keeps the original file type in most cases (labs from an interface get changed).

7. I get records and reports from other providers. Do I / can I provide access to these to patients? This may be something the practice decides on their own, but I would say if the patient requests their entire record, and this is part of it, then you would send it. If its in the imported items section, then you can send it to the portal just as you would a lab.

The one thing to remember about all of this is that at this time, there is nothing for you to do on the practice side. In the current stage, its all on the development side with getting development plans ready and declaring intent. You will most likely not see any change in how you deliver information till late next year.

If you, or anyone else on the board, has any questions. You are always free to reach out to me directly at mdabeck@harriscomputer.com

WOW!! Amazing Support!! (And NOT sarcastic, smiley face emoji!) Mark, that was way better answering than I had hoped for and very timely. I am sure this will be appreciated by our AC community. BTY, I didn't mean to rush you in my last post, I was just suspecting that I might have overreacted and the community was just tending to bigger fish that needed tempura batter and so on...

Thanks again, and keep up the good work!

Thanks Jack. I try to help out when I can.

Oh and the "request API access" link is now fixed, it should take you to a page that lets you fill out a technical support form, instead of trying to open a native email app.

As I understand it, these things are essential to the CURES act:

1. OpenNotes – all office visit notes, virtual office visit notes, and letters written for the patient are viewable by patients automatically after signing by the provider - I think AC can only send a summary if this option is checked in Updox settings? Although mine does not appear to be currently working?
2. Lab Reports, Path Reports, and Imaging Reports – viewable by patients immediately (before signing) - I guess we'd just need to send all these to patients?

Any other thoughts, or what else is AC working on here?

David M. Lee, MD
IM
Dallas, TX

Hi Dr Lee.

OpenNotes is something that is going to be incorporated in the new CCDA update coming in the later stages of the CURES act (end of 2022). For lab reports, you can currently send these to the patient portal in AC with a simple click (there is a check box on the sign off screen labeled "send to portal"). I am not aware of a requirement that says they need to be sent before signing. To me this doesn't make too much sense in the normal workflow of things... you would not have your staff call a patient about test results until you have reviewed them first, correct? I realize that could be different in every office, but I am thinking generally here. I will do a little more research here.

Thanks Mark -- that is a lot of good information.
I suppose we can get used to putting copies of our office notes and letters into the patient portal, but most of my patient population doesn't have any way of using the portal mechanism -- many of them have trouble with a telephone. The Cures Act seems to talk only about "electronic devices". I assume we are not required to print and mail copies to patients who can't use a portal and don't request records in the (up to now) usual way. Corrrect?

I have some concern about our responsibility to explain and possibly "correct" the notes when patients read and misunderstand them. Is that part of the Cares Act? Are we going to have to set up a secure email app of some kind to communicate with patients?

Hi Tom.

You are correct, the Cures Act is focused on the more electronic aspect of medical records. It also, however, focuses on patient choice. If the patient does not want to use the portal and prefers that you give them the medical records on paper, then that is perfectly fine. Its will be up to the patient how they receive their records.

As far as patient's interpreting the notes, I have not seen that as part of the Cures Act. It is definitely a possibility that patients will read the notes and interpret things the wrong way (Thanks, WebMD). I think this is something that may just be handled at the office level. Its no different than if patients received a copy of their medical record on paper and read them. Its just the delivery method has changed. As far as a secure email/messaging system. You already have that with the patient portal.

Hi Mark@AC,

I just received an email from our local medical society about a requirement to add a direct address into NPPES by April 5. Do you know how we can get this direct address set up? Here is what they sent us: https://www.hcms.org/tmaimis/HARRIS/Practice_Resources/HIT/Information_Blocking.aspx

Hi Serene,

Sure. Direct addresses are set up through the administrator options, under the "Patient Portal and Direct Messaging" option (its the button in the middle of the screen). This is the same screen that you would have set up your patient portal (you did set up a patient portal, right?).

In this screen, click on the "Activate/Deactivate" users button to open a list of users. Check of the box to make a user active. They will automatically be assigned a direct address (usually their first initial, last name, @ portal address, .amazing-direct.com). Click save to save this info.

Once you have the direct addresses, you will need to validate them with the Direct Trust. This only needs to be done once per practice.

- On the main screen of AC, click on the "Secure" button to open updox.
- Click on "menu", and then "Tools"
- Select the Option for "Direct Trust Activation" and follow the on screen steps to validate.

Once done, your address is ready to use.

Let me know if you run into any issues and I can help you out. My email is mdabeck@harriscomputer.com