• Simplification Ahead stamp

    Delay Information Blocking Deadline, AAFP Urges HHS 

    Firm Definitions, Administrative Simplification Needed, Academy Says

    Oct. 5, 2022, 3:55 p.m. News Staff — Family physicians and most other stakeholders need more time and improved guidance to ensure compliance with electronic health information rules — including a broad and potentially burdensome expansion of how EHI is defined — that take  effect Oct. 6, the Academy and numerous other groups told HHS recently.

    Female patient with male physician

    “Significant knowledge gaps and confusion still exist within the provider and vendor communities with respect to implementation and enforcement of information blocking regulations,” the AAFP and its co-signatories said in a Sept. 26 letter. The letter urged HHS to postpone the looming deadline by one year and cautioned against imposing fiscal penalties on clinicians without first providing them the opportunity to correct any violations.

    An Aug. 18 letter, also co-signed by the Academy, raised similar concerns while calling for a delay and asking regulators to “create a culture of learning on information sharing to ensure that health data is flowing across the entire ecosystem” rather than a culture focused on penalties.

    The information blocking conversation dates to 2016, when the 21st Century Cures Act codified the sharing of electronic health information among clinicians and charged HHS with identifying “reasonable and necessary activities that do not constitute information blocking.” HHS’ Office of the National Coordinator for Health IT established information blocking exceptions in a 2020 rule; Oct. 6 is the next compliance deadline along HHS’ timeline for implementation.

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    Over the past few years, the Academy has voiced support for federal efforts to improve interoperability and end unnecessary limits on the sharing of patients’ health information, noting that such advancements help family physicians coordinate team-based care. At the same time, the AAFP has steadily raised concerns about administrative complexity built into recent rulemaking — advocacy extended in the two recent letters the Academy co-signed.

    “Ultimately, our organizations seek assurance that stakeholders have the granular details they need to appropriately implement the new regulations as well as promote greater sharing of health data,” the August letter said, stressing the need for more guidance “to appropriately implement and properly comply with these new regulations as well as better empower patients to access their health information.”

    “A chief factor limiting compliance readiness is the widespread inability to support access, exchange and use of electronic health information,” the September letter said. “There is no clear definition of EHI, and there is a lack of a technical infrastructure to support its secure exchange.”

    In the absence of these elements, particularly given an unclear definition of EHI that could encourage clinicians to spend resources on sharing extraneous records, physicians face confusion and increased administrative complexity, the groups said. And the lack of detail about how infractions would be investigated, resolved or penalized, the letter added, has created “significant anxiety.”

    That correspondence echoed advocacy in the August letter, in which the AAFP and its co-signatories said, “We are increasingly concerned about the complexity as well as the lack of a clear and consistent understanding of the information blocking regulations across the community.” That community, the groups added, includes many independent, small, rural and solo medical practices that are “still unaware or underinformed about information blocking requirements.”

    That letter called on HHS to clarify a number of “major foundational concepts,” including:

    • What are good information sharing practices and how should they be implemented?
    • What actions can regulated actors undertake to demonstrate good intent for information sharing?
    • What constitutes a “request” for information sharing, and what should organizational processes be for evaluating whether it is a valid request?

    It also asked for “scenario-based FAQs” such as:

    • How should a clinician approach a situation in which they cannot do exactly what is asked of them in an information sharing request but may be able to provide the information in a different format?
    • How do they make a good faith compliance effort?
    • If an actor does not have the technology or technical functionality necessary to fulfill a request for EHI, does denial constitute an interference?

    For now, an AMA resource summarizes the requirements and provides a number of definitions. The American Health Information Management Association, an AAFP advocacy partner, has released a free 45-minute training video that gives an overview of this month’s expansion of the EHI definition and related regulatory considerations.