Proposed federal rules could change how electronic health records support nursing


The Federal Medicare and Medicaid Services Agency (CMS) released a draft rule on May 10 – the rule for inpatient prospective payment systems – that can help determine how hospitals are reimbursed for the provision of care. Despite the seemingly technical goal, the proposed regulations could change the way health organizations share data and report on the quality of the services they provide.

These rules affect several areas of hospital operations. In particular, the health IT components could significantly improve the way in which electronic health records (EHRs) help inform the activities of public health authorities, ensure that patients receive safe and effective care, and automatically report data to authorities . The changes would help modernize the way hospitals share information through their electronic record keeping systems so doctors and nurses can provide the best possible care.

The CMS announcement is only one step in the process. The draft rules can be commented on until June. The final version is expected to come into force in early 2022.

Better data sharing to support public health

The COVID-19 pandemic has highlighted the importance of fast, accessible data in managing public health crises and the challenges posed by the lack of that data. In previous years, it was optional for hospitals and providers to be able to send certain information electronically to public health authorities. The proposed CMS rules would require hospitals participating in the Medicare Interoperability Promotion (PI) program – a payments program that helps determine hospital reimbursement rates – to prioritize reporting their data electronically to public health authorities. This change should give these agencies more complete and up-to-date information to inform their responses to future health emergencies.

Public health data reporting broadly covers four main categories: case reporting, which provides health departments with information about patients with specific medical conditions; Laboratory reporting, which tells health departments how many people have tested positive for a disease; Syndrome monitoring, which provides community-level data on health threats; and vaccination registry data, which provides information on individuals’ vaccination status and community-wide vaccination rates. According to the CMS rules, hospitals in the PI program would have to confirm that their systems can electronically share data for all four use cases with public health authorities. Such connectivity would ensure that authorities can track health concerns and act quickly based on the best information available.

Easier access to data for patients and providers

The CMS proposal also includes an optional measure in the PI program that will allow hospitals to demonstrate that they are sharing important clinical information with other providers. Hospitals could do this if their EHRs can send, receive, and incorporate data through Health Information Exchange (HIEs). These are institutions in states or regions that help share information between groups that have legitimate needs, including other providers, hospitals, and public health authorities.

In particular, systems would have to be able to exchange data contained in the Common Clinical Data Set or in the current version of the US core data for interoperability. Both contain the most important information about patients, such as: These include demographics, a list of their medications and medical histories, allergies, vaccinations, and other background information clinicians need to provide quality care. To exchange data with HIEs, hospitals would have the option of using APIs (Application Programming Interfaces), tools that allow information from multiple sources to be gathered and consolidated in one place. In addition, these APIs could be based on the Fast Healthcare Interoperability Resources standard, the most widely used standard in healthcare IT. This would allow providers to access specific information instead of searching through pages with unnecessary or unhelpful records.

Greater focus on IT security in the health sector

The proposed rule would also require hospitals to regularly assess the safety of their EHRs and check whether their design or implementation in healthcare facilities could inadvertently lead to medical errors.

To do this, hospitals would use the Safety Assurance for EHR Resilience (SAFER) guides, a series of nine checklists developed by the Office of the National Health Information Technology Coordinator (ONC), the agency responsible for overseeing health IT. The guides include categories such as system interfaces or configuration, patient identification, and reporting and tracking of test results, each of which can cause errors that put patients at risk. To ensure compliance, hospitals would need to confirm that they have completed the assessments for all nine guides and repeat the process annually.

Increased use of APIs to exchange information

The draft regulation also includes a request for feedback on how to encourage greater use of APIs in healthcare. These interfaces are often used in other parts of the economy, e.g. B. to help people book flights or hotel stays on the Internet. However, their use in healthcare has been limited. APIs could be used to automate data reporting for EHRs. For example, CMS asks hospitals to report certain quality measures annually, e.g. B. the frequency of hospital-acquired infections to gather information about health care outcomes. Using APIs to perform this reporting could reduce the burden on hospitals.

ONC develops rules to regulate the types of data that APIs must be able to access and share with EHRs. Similarly, CMS is collecting feedback to expand the use of APIs for data exchange and to find out how these tools can streamline quality reporting programs and reduce the burden on hospitals and providers of automated data exchange.

Beyond these suggestions, additional rules may be needed to encourage vendors to make this and related goals a priority. However, the CMS proposal marks a step towards more secure and more effective IT health systems. Implementing these rules would help better care for patients and support communities affected by health crises.

Molly Murray leads the Pew Charitable Trusts’ health information technology project.


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