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The Free Exchange of Health Information: Preventing Information Blocking

Hess, Cathy Thomas, BSN, RN, CWCN

doi: 10.1097/01.ASW.0000542320.66822.20
DEPARTMENTS: PRACTICE POINTS

Cathy Thomas Hess, BSN, RN, CWCN, is Vice President and Chief Clinical Officer for Wound Care, Net Health. Ms Hess presides over Net Health 360 WoundExpert Professional Services, which offers products and solutions to optimize process and workflows. Address correspondence to Ms Hess via e-mail: chess@nethealth.com.

In continuing our efforts to understand the most important aspects of the Merit-based Incentive Payment System (MIPS), this month’s installment of Practice Points reviews the intent and reporting process for “Information Blocking.”

Guidance for this column was found within the QPP Fact Sheet entitled “The Merit-based Incentive Payment System (MIPS) Advancing Care Information Prevention of Information Blocking Attestation: Making Sure EHR Information Is Shared.”1 For the full document, please visit www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/ACI-Information-Blocking-fact-sheet.pdf.

To prevent actions that block the exchange of health information, the Medicare Access and CHIP Reauthorization Act of 2015 and the Quality Payment Program (QPP) final rule require MIPS-eligible clinicians to show that they have not knowingly and willfully limited or restricted the compatibility or interoperability of their certified electronic health record technology (CEHRT). The MIPS-eligible clinician can show that he/she is meeting this requirement by attesting to three statements about how their CEHRT is implemented and used. Together, these three statements are referred to as the “Prevention of Information Blocking Attestation.” Here are some frequently asked questions about this attestation and information blocking.

Q: Do I have to attest?

A: If you are a MIPS-eligible clinician who reports on the advancing care information performance category, then you must complete the Prevention of Information Blocking Attestation.

If you are reporting as a group, the Prevention of Information Blocking Attestation applies to all MIPS-eligible clinicians within the group. Therefore, if one MIPS-eligible clinician in the group fails to meet the requirements of the attestation, then the whole group would fail to meet the requirement.

Q: What actions are required?

A: If you want to earn a score for the advancing care information performance category, you have to act in good faith when you implement and use your CEHRT to exchange electronic health information. This includes working with technology developers and others who build your CEHRT to make sure the technology is correctly used, connected, and enabled to meet applicable standards and laws. You must also ensure that your organizational policies and workflows do not restrict the CEHRT’s functionality in any way. For example, if your CEHRT can give patients access to their electronic health information or exchange information with other MIPS-eligible clinicians, your practice must use these capabilities.

The Centers for Medicare & Medicaid Services recognizes that circumstances beyond a MIPS-eligible clinician’s control may limit the exchange or use of electronic health information. This is why the Prevention of Information Blocking Attestation focuses on (1) whether you act in good faith to exchange electronic health information and (2) your particular situation. This focus takes into account a MIPS-eligible clinician’s individual circumstances, such as

  • practice or organization size,
  • how much technology there is, and
  • what the CEHRT can do.

However, the attestation does not

  • assume how much clinicians know about technology or
  • hold clinicians responsible for outcomes they cannot reasonably influence or control.

Q: What statements do I attest to?

A: The Prevention of Information Blocking Attestation has three related statements that are based on section 106(b)(2) of the Medicare Access and CHIP Reauthorization Act about how MIPS-eligible clinicians implement and use CEHRT. The three statements are as follows:

Statement 1: A MIPS-eligible clinician must attest that he/she did not knowingly and willfully take action (such as to disable functionality) to limit or restrict the compatibility or interoperability of CEHRT.

Statement 2: A MIPS-eligible clinician must attest that he/she implemented technologies, standards, policies, practices, and agreements reasonably calculated to ensure, to the greatest extent practicable and permitted by law, that the CEHRT was, at all relevant times

  • connected in accordance with applicable law;
  • compliant with all standards applicable to the exchange of information, including the standards, implementation specifications, and certification criteria adopted at 45 CFR Part 170;
  • implemented in a manner that allowed for timely access by patients to their electronic health information (including the ability to view, download, and transmit this information); and
  • implemented in a manner that allowed for the timely, secure, and trusted bidirectional exchange of structured electronic health information with other health care providers (as defined by 42 USC 300jj(3)), including unaffiliated providers, and with disparate CEHRT and health information technology vendors.

Statement 3: A MIPS-eligible clinician must attest that he/she responded in good faith and in a timely manner to requests to retrieve or exchange electronic health information, including from patients, health care providers (as defined by 42 USC 300jj(3)), and other persons, regardless of the requestor’s affiliation or technology vendor.

Statement 1 requires clinicians to demonstrate that they did not restrict health information; statements 2 and 3 build on statement 1, to help providers understand what is required, comply with those requirements, and actually provide the attestation. Statement 2 focuses on implementation, and statement 3 focuses on actual use.

You can still attest to statement 3 if, in good faith, you restricted access to information for reasonable purposes, such as to make security upgrades or keep patients safe. You also will not be responsible for restricted exchange or interoperability that you could not have reasonably controlled, such as during a natural disaster.

Q: Do I have to show any documentation to attest?

A: You do not have to provide any documentation to show you have acted in good faith to

  • implement and use your CEHRT to support the appropriate exchange of electronic health information or
  • promote information exchange.

Investing time and expertise in developing appropriate workflows is imperative. When developing your MIPS workflows, ensure you understand how the workflow design will affect your documentation, including through managing messages, scheduling patients, checking in and rooming patients, conducting and documenting the patient encounter, and discharging the patient. Most important, understand the measures to which you will be attesting. If you have questions, be sure to delve into the QPP website for more information.

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Reference

1. Centers for Medicare & Medicaid Services. Quality Payment Program. The Merit-based Inventive Payment System (MIPS) Advancing Care Information Prevention of Information Blocking Attestation: Making Sure EHR Information Is Shared. October 2017. www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/ACI-Information-Blocking-fact-sheet.pdf. Last accessed June 25, 2018.
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