CMS Draft Rule Could Modernize EHR Data Exchange, Public Health

A CMS draft rule set to improve the hospital reimbursement process could also transform patient data exchange, effectively revolutionizing the EHR to improve patient safety and support public health needs, according to a recent Pew article.

On May 10, CMS proposed the Inpatient Prospective Payment Systems rule (IPPS), which outlines revisions to hospital reimbursement practices.

In the past, hospitals and providers could choose whether they sent certain information to public health agencies. However, after COVID-19 underscored the importance of data in response to public crises, the proposal would require hospitals participating in Medicare’s Promoting Interoperability (PI) reimbursement program to electronically report their data to public health agencies.

The proposed public health reporting requirements would include: case reporting, which gives health departments data on patients with certain conditions; lab reporting, which outlines how many people have tested positive for an illness; syndromic surveillance, which provides community-level data on health threats; and immunization registry data, including information about individuals’ vaccine status and community vaccination rates.

The proposed regulations may also provide greater health IT security while improving patient and provider access to health information, according to Pew.

If passed, the rule would require hospitals to assess the safety of their EHRs using the ONC’s Safety Assurance for EHR Resilience (SAFER) Guides. This would allow hospitals to flag design features or implementation practices that may contribute to medical errors, Pew noted.

Additionally, there is an optional measure in the proposal that allows hospitals in the PI program to show that they are sharing valuable clinical information with other providers.

One way to demonstrate this is for hospitals to exchange data with health information exchanges (HIEs), entities that help share information among providers, hospitals, and public health agencies.

“In particular, systems would have to be able to exchange data included in the Common Clinical Data Set or the current version of the United States Core Data for Interoperability,” Pew noted. “Both include the most important information about patients, such as demographics, a list of their medications and medical histories, allergies, immunizations, and other background that clinicians consistently need to provide quality care.”

To exchange data with HIEs, hospitals could utilize application programming interface (APIs) tools to aggregate data from multiple sources.

“Moreover, those APIs could be based on the Fast Healthcare Interoperability Resources standard, the most commonly used standard in health IT,” Pew noted. “This would allow providers to access specific pieces of information, rather than having to sort through pages of unnecessary or unhelpful records.”

The CMS draft rules also requested feedback on how to encourage API use in healthcare. While the interfaces are commonly used in other sectors of the economy, such as to help people book airline flights online, they are not as popular in the healthcare sphere.

“APIs could be used to automate data reporting for EHRs,” Pew explained. “For example, CMS asks hospitals to annually report certain quality measures, such as rates of hospital-acquired infections, to collect information on health care outcomes. Using APIs to conduct this reporting could reduce the burdens on hospitals.”

Currently, ONC is developing rules regarding the kinds of data that APIs must be able to access. CMS is also collecting feedback to expand the use of APIs in patient data exchange and quality reporting programs.

“Beyond these proposals, additional rules could be needed to encourage vendors to make these and related goals a priority,” Pew said. “Still, the CMS proposal marks a step toward safer, more effective health IT systems. And implementation of these rules would help bring better care for patients and support for communities facing health crises.”

The draft rules are open for comments through June, and the final version is expected to take effect at the beginning of 2022.