PROVIDERS GUIDE TO CURES ACT
To comply with the new Information Blocking rules that are part of the Cures Act, we are providing some helpful guide about this change. These new rules significantly expand what information must be made accessible to your patients and require you to supply easy access to medical records.
For this reason, patients that do not have a Portal Connect membership can now request copies of their medical records, via the PortalConnect website without being subscribed.
Our team will receive the request via support ticket and will redirect it to your practice for assistance. It will be up to your discretion to contact the patient directly and provide the record via any preferred method.
We highly recommend adjusting your “Visit Note Sharing” Settings in Hello Health to share by default the “Chief Complaint” and “Assessments and Plans” in every patient visit note. This will guarantee that the information is available via PortalConnect access to your patients.
If you have a preferred email for us to send you the “Medical Record Request” from patients that decide not to access via PortalConnect, please let us know by emailing our support team to firstname.lastname@example.org subject “Record Request”.
We have also included a one-pager communication to have available for your patients at the front desk and as well as from your website.
Please do not hesitate to let us know in case of any questions or concerns.
Lot of good information is available on https://www.opennotes.org/onc-federal-rule/
THE FOLLOWING TABLE IS TO BE USED AS AN ADDITIONAL RESOURCE ONLY AND IS NOT LEGAL OR COMPLIANCE ADVISE ON THE CURES ACT .
Please consult a healthcare compliance consult or a Healthcare Attorney
Q. What health information constitute EHI that needs to be shared?
The information blocking requirements of the Cures Act only relate to EHI as defined by the United States Core Data for Interoperability (USCDI). Currently, the USCDI definition of EHI includes only specific medical information, not billing records. In addition to the elements in the current Common Clinical Data Set (CCDS) which serves as the foundation of the Summary of Care and Referrals used by physicians to transmit patient data, USCDI has recently announced that EHI also includes the following clinical note categories: (1) history and physicals, (2) progress notes, (3) procedure notes, (4) consult notes, (5) imaging reports, (6) laboratory reports, (7) pathology reports, and (8) discharge summaries[applicable to inpatient settings]
Q. Do healthcare providers need to make all EHI available to patient upon request?
Providers are only required to provide EHI defined by the USCDI that is requested by patients. While there is no requirement for providers to make EHI available to patients who have not requested it however a delay in the release or availability of EHI in response to a request could mount to Information Blocking. Please be aware of HIPAA requirement to provide medical record to patients upon requests.
Q. Are there any exceptions provided within the framework of the Cures Act in regard to sharing EHI?
There are complex situations in which information can be blocked—and these are called Exceptions. Unless one of the Exceptions applies, clinical notes must not be blocked.For complete details, refer to the HealthIT.gov Information Blocking FAQ.Summary of the Exceptions
A group called actors are referred to throughout the rule. Actors include:
Healthcare providers (including physicians, physician assistants, nurse practitioners, nurses, social workers, chaplains, and therapists)
Health information networks or health information exchange
Health IT developers of certified health IT (e.g., electronic health record vendors)
Featured below are Exceptions outlined by the final rule. The Exceptions fall into two categories (source).
Category 1. Exceptions that involve not fulfilling requests to access, exchange, or use electronic health information (EHI)
Preventing Harm Exception: It will not be information blocking for an actor to engage in practices that are reasonable and necessary to prevent harm to a patient or another person, provided certain conditions are met.
Privacy Exception: It will not be information blocking if an actor does not fulfill a request to access, exchange, or use EHI in order to protect an individual’s privacy, provided certain conditions are met.
Security Exception: It will not be information blocking for an actor to interfere with the access, exchange, or use of EHI in order to protect the security of EHI, provided certain conditions are met.
Infeasibility Exception: It will not be information blocking if an actor does not fulfill a request to access, exchange, or use EHI due to the infeasibility of the request, provided certain conditions are met.
Health IT Performance Exception: It will not be information blocking for an actor to take 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.
Category 2. Exceptions that involve procedures for fulfilling requests to access, exchange, or use EHI
Content and Manner Exception: It will not be information blocking for an actor to limit the content of its response to a request to access, exchange, or use EHI or the manner in which it fulfills a request to access, exchange, or use EHI, provided certain conditions are met.
Fees Exception: It will not be information blocking for an actor to charge fees, including fees that result in a reasonable profit margin, for accessing, exchanging, or using EHI, provided certain conditions are met
Licensing Exception: It will not be information blocking for an actor to license interoperability elements for EHI to be accessed, exchanged, or used, provided certain conditions are met.
Details regarding conditions that must be met to meet these exceptions can be found on the ONC website.
Q. Do healthcare providers have discretion in sharing health records with patients? How do I handle such exceptions?
Under the Cures Rule, in certain specified situations information can be blocked (or “hidden”) from patient access on online portals—these are called Exceptions. As examples, clinicians can block information:If they believe a patient will harm another person or themselves as a result of reading the informationIf they need to protect the security of another person’s electronic health information (e.g., a mother’s health information in a child’s record)Unless one of the Exceptions applies, clinical notes must not be blocked. Details about exceptions are outlined at HealthIT.gov.Learn more about how the Cures Rule applies to open notes.
Q. How might healthcare providers change the way they document patient notes as a result of Information Blocking rule?
In several studies of how open notes affect the way doctors prepare notes, the majority report they don’t change the way they write their notes. But many clinicians experienced in sharing notes report their writing does change over time, feeling overall that it becomes more valuable, certainly to patients.Few report “dumbing down” their language, but they find themselves using fewer abbreviations and trying to avoid language that could appear judgmental to patients. Some report modulating their practice such that they become “teaching notes.”In general, patients do not expect doctors to write notes in layperson language, and more than 90% in one large study report understanding their notes well. Patients not bothered by terms they don’t understand, and they are happy to research terms. They feel reading notes helps them prepare more focused questions for clinicians. Overall, they express considerable enthusiasm for having a window into more information about their health.