Information Blocking and Interoperability in Healthcare

Healthcare interoperability regulations are aimed at facilitating and encouraging information sharing among healthcare stakeholders and ensuring secure exchange of electronic health information (EHI) between different systems. Key requirements relate to patient access to EHI, exchange of EHI between providers and payors, payor-to-payor data exchange, application programming interfaces (API) implementation, data security, and quality data reporting, among other issues.

Healthcare interoperability requirements impact a wide range of industry stakeholders involved in the creation, exchange, and use of health information and data. Stakeholders include patients, healthcare providers, payors, researchers, health IT developers, revenue cycle management companies, and other service providers.

Failing to comply with the requirements can lead to financial penalties, loss of federal certification, and potential harm to patient care. The US Department of Health and Human Services (HHS) Office of Inspector General (OIG) can investigate claims of information blocking and impose civil monetary penalties of up to $1 million (as adjusted for inflation) per information blocking violation against certified health IT developers, health information networks and health information exchanges. Penalties called “appropriate disincentives” are also authorized for information blocking violations by healthcare providers that participate in certain Medicare programs.

The Promoting Interoperability (PI) Program, formerly known as Meaningful Use, is a Centers for Medicare & Medicaid Services (CMS) program designed to encourage eligible professionals (EPs), eligible hospitals, and Critical Access Hospitals (CAHs) to adopt and meaningfully use certified Electronic Health Record (EHR) technology. It aims to improve patient care by facilitating the electronic exchange of health information and promoting data sharing.

The PI measures and requirements are typically updated each year through the relevant payment rule – the Inpatient Prospective Payment System (IPPS) rule for hospitals and CAHs and the Physician Fee Schedule, Merit-Based Incentive Program (MIPS) for EPs.