Solving the Data Sharing Dilemma for Stakeholders
To promote data sharing, CMS and ONC jointly released the CMS Interoperability Rule and the ONC Cures Act Rule on March 9, 2020, as part of the 21st Century Cures Act. The rules cover data sharing to advance care continuity, patient access to information, and prevention of information blocking.
“HealtHIE Alert”by HealtHIE Georgia for Rural Georgia
Final Rule: Condition of Participation (CoP) for Electronic Notifications - Here’s how we support the following rule requirements:
1. Who needs to do it and when does it start?
All Medicare and Medicaid participating hospitals (including psychiatric hospitals and critical access hospitals (CAHs)) that utilize an EMR or other electronic administrative system and that system has the capability of using the HL7 Messaging Standard Version 2.5.1.
The requirement will be effective starting in May 2021.
2. What does it entail?
The hospital must show its system:
- Is fully operational and complies with all applicable laws and the patient’s expressed privacy preferences regarding sending notifications
- Sends real-time notifications that include the name of the patient, the name of the treating practitioner, and the name of the sender
- Sends near-real time notifications for a patient in the Emergency Department, Inpatient, and Observation Status
3. In addition to the system requirements
The hospital must demonstrate that it has made a reasonable effort to ensure that their system sends the notifications to:
- All applicable post-acute care service providers/suppliers
- Any of the following practitioner(s)/group(s)/entities that need to receive notifications of the patient’s status for treatment, care coordination, or quality improvement purposes:
Admission, Discharge, and Transfer (ADT) Event Notifications - (Applicable May 1, 2021)
The CMS rule establishes new Conditions of Participation (CoPs) requiring hospitals, including psychiatric hospitals and CAHs, to send electronic patient event notifications of a patient’s admission, discharge, and/or transfer to another healthcare facility or to another community provider or practitioner. Here’s how we support this requirement:
HealtHIE Alert stands out from simple ADT alerting capabilities and encounter notification alerting because of HGaC’s Georgia’s reach into provider EMRs and the product’s innate ability to streamline the patient/provider/caregiver relationship/roster. Also, HealtHIE Alert extends alerting to external providers and payers who are part of HGaC trust communities and delivers notifications directly into the workflow of receiving provider’s EMRs (without requiring a costly interface).
Use HealtHIE AlertS
- Post-acute care organization – utilizing alerts to speed authorizations and improve home care coordination.
- Integrated health care system – delivering automated ADT health alerts to cut costs, improve care, and reduce ED use.
- Commercial health plan – closing care gaps, within providers EMR workflows, to meet quality/cost measurement thresholds aligned with value-based reimbursement program.
- Medicaid – managing high risk patients, to improve transitions of care, enhance medical decision making and reduce costly and preventable readmissions.
Patient Access API (Applicable July 1, 2021)
This rule requires CMS-regulated payers to implement and maintain a secure, standards-based (HL7 FHIR Release 4.0.1) API that allows patients to easily access their claims and encounter information.
HGaC supports this in several ways:
- Security model – HGaC the security connectivity between the patient application and the EMR. Setting up an ID for every patient on every application will be challenging for EMR vendors.
- Enabling the provider EMR - by creating an interface between the FHIR query and the EMR.
- Leveraging the FHIR query for Payer (and other entity query) makes it far easier for the payer to get certain information. This is the intent of the DaVinci project.