What You Need To Know
21st Century Cures Act Final Rule
Information Blocking Rule Compliance
The 21st Century Cures Act, Information Blocking Rule mandates that patients have rapid, free and full access upon request to test results, medication lists, referral information, and clinical notes, all in electronic formats by default.Information Blocking Rule
As of October 6, 2022, the definition of electronic health information (EHI) in the 21st Century Cures Act expanded to include all electronic Protected Health Information (ePHI) that the patient has the right to access under the Health Insurance Portability and Accountability Act (HIPAA). Upon the expansion of the EHI definition, all notes in the medical record must be shared with the patient.Open Notes
Notes written by doctors, nurses, therapists, or other health professionals to describe interactions with patients (e.g., visit notes, clinic notes, progress notes, or chart notes) are part of the medical record.Epic- MyChart
HMH relies on MyChart to provide secure patient access to their ePHI as required by the 21st Century Cures Act. Patients can also securely message their doctor’s office and make appointmentsEpic Do Not Share Functionality
In very limited circumstances, if the Note meets an “exception” under the Rule, a provider can take steps to prevent a note from being shared via choosing the Epic Do Not Share functionality. Three of the exceptions are available and must be evaluated on a case by case basis. There is a hard stop in Epic and the Provider will be required to document the reason for not sharing the note with a patient. The Final Rule defines and provides examples of information blocking. In addition, it outlines eight (8) detailed practices and activities that would not constitute information blocking even if they do in fact interfere with the access, exchange, or use of EHI. The Final Rule deems these practices and activities reasonable and necessary to further the Act’s goals, and refers to them as “exceptions.” EHI: It is not considered information blocking if:- Preventing harm exception: a covered component engages in practices that are reasonable and necessary to prevent harm to a patient or another person, provided certain conditions are met (45 CFR § 171.201).
- Privacy exception: a covered component does not fulfill a request to access, exchange, or use EHI in order to protect an individual’s privacy, provided certain conditions are met (45 CFR § 171.202).
- Security exception: a covered component interferes with the access, exchange, or use of EHI in order to protect the security of EHI, provided certain conditions are met (45 CFR § 171.203).
- Infeasibility exception: a covered component does not fulfill a request to access, exchange, or use EHI due to the infeasibility of the request, provided certain conditions are met (45 CFR § 171.204).
- Health IT performance exception: a covered component takes reasonable and necessary measures to make health IT temporarily unavailable or to degrade the health IT’s performance for the benefit of the overall performance of the health IT, provided certain conditions are met (45 CFR § 171.205).
- Content and manner exception: a covered component fulfills a request to access, exchange, or use EHI in any manner requested or in an alternative manner, provided certain conditions are met, using (i) certified health IT specified by the requestor; (ii) content and transport standards specified by the requestor and published by the federal government or a standards-developing organization accredited by the American National Standards Institute; or (iii) an alternative machine-readable format, including the means to interpret the EHI, agreed upon with the requestor (45 CFR §171.301). This exception both establishes the content a covered component must provide in response to a request to access, exchange, or use EHI in order to satisfy the exception, and establishes the manner in which a covered component must fulfill a request to access, exchange, or use EHI in order to satisfy this exception.
- Fees exception: a covered component charges fees, including fees that result in a reasonable profit margin, for accessing, exchanging, or using EHI, provided certain conditions are met (45 CFR §171.302).
- Licensing exception: a covered component licenses interoperability elements for EHI to be accessed, exchanged, or used, provided certain conditions are met (45 CFR §171.303).