ONC Proposed Rules on Info Blocking, Prior Auth, and More Shine Light on Advancing Interoperability

This week, the Office of the National Coordinator for Health Information Technology (ONC) released a set of proposed rules that aim to empower patients with greater access to their health data and address a longstanding challenge in the healthcare industry – the lack of interoperability among electronic health records (EHRs) and other health IT systems. 

The 21st Century Cures Act, which was signed into law in 2016, was a landmark piece of legislation that sought to accelerate data modernization while also improving healthcare delivery and outcomes. One of the key provisions of the law was the requirement for healthcare providers to use EHRs that are capable of sharing data with other systems. This was achieved, with the vast majority of health records digitized, but the promise of making it so that these electronic medical charts follow patients wherever they go has gone unfulfilled. 

With the Trusted Exchange Framework and Common Agreement (TEFCA) in play, we are getting closer – but we are not there yet. We’re in the midst of a titanic shift in healthcare and data is at the center.

The ONC’s Health Data, Technology and Interoperability (HTI-1) Notice of Proposed Rulemaking (NPRM) released April 11 proposes several enhancements to the ONC Health IT Certification Program to advance interoperability, improve transparency, and support the access, exchange, and use of electronic health information for the betterment of patient care.

They include:

  • Implementing the Electronic Health Record Reporting Program as a new Condition of Certification for developers of certified health IT.
  • Modifying and expanding exceptions in the information blocking regulations to support information sharing.
  • Revising several Certification Program certification criteria, including existing criteria for clinical decision support (CDS), patient demographics and observations, electronic case reporting, and application programming interfaces for patient and population services.
  • Adopting the United States Core Data for Interoperability (USCDI) Version 3 as a standard within the Certification Program and establishing an expiration date for USCDI Version 1 as an adopted standard within the Certification Program.
  • Updating standards and implementation specifications adopted under the Certification Program to advance interoperability, support enhanced health IT functionality, and reduce burden and costs.

The ONC rule also proposes new policies that could bolster transparency and trust in clinical decision support (CDS) algorithms used in healthcare by making more information available.

The rules also address prior authorization, seeking to streamline the process and make it more efficient. This often time-consuming process can delay access to medical procedures or prescribed medicines, so these improvements will have a clear and immediate impact on patient care. It will also reduce the administrative burden placed on healthcare providers, who pressed the CMS on this issue back in January. 

Our Chief Medical Officer Steven Lane, MD, MPH, co-authored the peer-reviewed paper Could an artificial intelligence approach to prior authorization be more human? In it, they assert that prior authorization has become an informatics issue – in other words, it’s about the data. 

In fact, the common denominator for all of the improvements proposed by the ONC is data. For so long, in healthcare, we were stumbling around in the dark without a flashlight. Healthcare needs data to shine into every corner of the ecosystem. 

At Health Gorilla, we believe that interoperability is essential for driving innovation in healthcare and improving patient outcomes. As CEO and Co-founder of Health Gorilla, I believe these proposed rules represent a significant step forward in our shared goal of improving healthcare interoperability and empowering patients with greater access to their health data.