In February, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator (ONC) for Health Information Technology released a set of proposed rules to address interoperability, information blocking, and patient access to data and electronic health record (EHR) certification criteria.

ASN has expressed its support for this overall proposed rule set to promote electronic data exchange and stop data blocking to improve health care quality. These will ensure that patients have timely access to important health information and have the ability to share it confidentially with the physician of their choice.

The proposed rules cover the following general descriptions:

• The CMS Interoperability and Patient Access Proposed Rule outlines opportunities to make patient data transparent, useful, and transferable through secure and standardized formats.
• The ONC proposed Interoperability, Information Blocking and ONC Health IT Certification Program Proposed Rule details proposals that further advance interoperability and patient access to health information and implements components of the 21^st Century Cures Act.
   

While ASN supports the general direction CMS and ONC are taking, there are several items of concern that the society urged them to resolve in final rulemaking or during a period of delayed implementation. Here are those concerns :

1. Definitions

Several terms are in need of more clarity regarding what is included and what is not. The two most significant terms are “electronic health information (EHI)” and “updated certified criteria”. A clear definition of EHI is critical to prevent unintended data blocking. ASN is very concerned regarding how open-ended this definition is and what it means to clinicians as they prepare their notes.

2. Implementation Timeline

ASN joined other societies in expressing concerns that the timeline is too compressed and may cause significant unintended consequences that could be avoided through stepwise implementation. ASN believes it makes more sense to accomplish EHR compliance before mandating usage by already overburdened clinicians who will need time to prepare their practices through training and administrative planning. While ASN will plan efforts to educate its members about the coming changes, the society urged CMS and ONC to develop resources to help clinicians prepare well in advance of the new requirements.

3. Burden and Information Overload

One point of concern to ASN is a proposal to require that clinicians close out an encounter in the patient record within one day. ASN pointed out that with highly complex patients, such as those with advanced kidney diseases, the need for additional labs, robust feedback, and second opinions that go into treatment decisions, often cannot be completed in a day. In addition to encouraging CMS and ONC to not include that proposal, ASN asked them carefully monitor costs associated with compliance to the proposals to avoid undue burden on clinicians.

4. Dialysis Facilities

Inclusion of dialysis units, most often separate from larger healthcare systems or physician practices, is not specifically mentioned in the rule. Dialysis patients can receive very segmented care partly because of EHR interoperability. ASN encouraged CMS and ONC to consider including dialysis facilities in the finalized rule.

ASN also raised HIPAA standards that it would like to have more clearly addressed in the final rule.