CMS, ONC finalize rules on interoperability, patient access to health records

CMS and the HHS Office of the National Coordinator (ONC) for Health Information Technology finalized a pair of complementary rules on March 9 aimed at improving interoperability and providing patients with free and secure access to their health data.

The Interoperability and Patient Access final rule (CMS-9115-F) outlines several new policies to enhance patient access to their health information. Among the most important is the implementation of a standard application programming interface (API) for all CMS-regulated payers. Beginning January 21, 2021, payers must utilize a Health Level 7® (HL7) Fast Healthcare Interoperability Resources® (FHIR) API that allows patients to easily access their claims data, as well as a defined sub-set of their clinical information, through third-party applications of the patients’ choice. Patients will be able to take their health and claims data with them as they navigate through the healthcare system and move to different health plans and providers.

In addition, CMS-regulated payers will be required to make provider directory information publicly available via the standard API. According to CMS, this change will “encourage innovation” by allowing third-party application developers to access information and in turn create services that will connect patients with providers.

A companion rule issued by the ONC establishes new regulations to prevent information-blocking practices by healthcare providers, developers of certified health IT, health information exchanges, and health information networks. The rule, part of the 21st Century Cures Act, also identifies eight “reasonable and necessary activities” that do not constitute information blocking. Finally, the ONC’s rule updates certification requirements for health IT developers.