Stream: implementers
Topic: Cures act effects
Itay Goren (Apr 06 2021 at 14:11):
As far as I understand, the 21CC cures act, all providers must provide a FHIR endpoint until April 5th 2021 which has passed.
If I’m correct, they must publish an available FHIR endpoint which we can access.
Did I understand correctly?
If so, I see that a lot of providers that don’t have a valid FHIR endpoint or their authentication website is down.
While integrating with OpenEpic I found out that about 50 out of their ~380 providers don’t work.
When talking to OpenEpic, I understood that it’s under the provider’s responsibility and not their.
Contacting 50 providers by email is a lot of work and it sounds like there should be an easier way to do so if they must provide an API by law.
Am I missing anything?
David Pyke (Apr 06 2021 at 14:29):
ONC delayed the onsent due to COVID. So, it's still in progress
Cooper Thompson (Apr 06 2021 at 17:05):
The April 5 date is when Info Blocking rules go into effect. The explicit FHIR endpoint publishing requirement is tied to certification 45 CFR 170.404(b)(2), which is later. Though there is a tie-in for endpoint publishing for Info Blocking, it is less well defined. For certification the requirement is technically for certified HIT vendors to publish URLs for their customers. Which is tricky if the customer's FHIR endpoint uses non-certified tech in front (e.g. API manager facades), but we'll figure that out...
Cooper Thompson (Apr 06 2021 at 17:11):
EHRs will be responsible for publishing FHIR endpoints when certification timelines hit. However, for Info Blocking (4/5), the providers can choose how they intend to comply. Because EHRs don't need to support all USCDI in FHIR until certification, providers likely can't meet USCDI Info Blocking obligations with FHIR alone until they move to a certified version (and even then, Info Blocking isn't just about FHIR).
Cooper Thompson (Apr 06 2021 at 17:15):
Also, I do want to temper expectations around FHIR endpoints. The certification part of the rule only requires certified EHRs to publish endpoints associated with certified HIT Modules. Many providers use dozens or hundreds of HIT systems, and most of those won't be certified. So USCDI data that is stored outside the certified EHR may not be available via FHIR, or it might be available, but from a different FHIR endpoint that may have different publishing requirements. So if you are looking to get all USCDI data from an organization, you may need to query multiple FHIR endpoints, and use other channels for data not available via FHIR at all. The ONC FAST endpoint directory project may eventually help with the non-certified HIT endpoint publishing challenge, but you'll still have non-FHIR USCDI data scattered around.
Cooper Thompson (Apr 06 2021 at 17:16):
From an Info Blocking perspective, providers will likely eventually publish all their FHIR URLs, both for certified and non-certified HIT, but many non-certified HIT don't have a lot of FHIR support yet, so there aren't endpoints to publish. So their Info Blocking obligations will likely involve content and manner discussions to get you the data you need from those systems via non-FHIR channels.
Cooper Thompson (Apr 06 2021 at 17:36):
Itay Goren said:
if they must provide an API by law.
Also, this isn't really the right way to look at things. Info Blocking rules means that if a provider has an API, then they shouldn't block access to it. However there isn't anything that actually requires them to have an API in the first place. There are upcoming incentive programs that encourage the use of certified HIT, however some providers may choose not to participate in those incentive programs, so they don't need to use certified HIT, so they don't need to have an API at all. They still need to not Info Block, but that doesn't necessarily imply they need an API.
Craig McClendon (Dec 07 2021 at 20:09):
Is anyone aware of a concise/specific summary of the Cures Act requirements as they related to providers/EMRs? CMS did a pretty good job summarizing the requirements for payers, but the ONC site is still fairly vague (to me) as to the specific hard requirements for providers.
David Pyke (Dec 07 2021 at 20:35):
The ONC has a whole subset of their website about it. https://www.healthit.gov/curesrule/ Unless you have specific questions, it's all there
Craig McClendon (Dec 07 2021 at 22:01):
Perhaps I'm not looking in the correct place on the ONC site. I see it talking about the goals and benefits, but not so much the specific requirements.
For example, under Patient Access it says things like:
The core goal of the health IT portion of the Cures Act is to provide patients with control of their health care and their medical record through smartphones and modern software apps.
But I don't see where it says specifically what is required and for whom.
The CMS site very specifically lays out that one must expose these FHIR APIs by this date if you participate in these programs. I was hoping to find something similarly simple to point to re: provider systems - short of reading the entire final rule in the federal register.
I've clicked all through the ONC site and can't seem to find a similar summary or fact sheet.
David Pyke (Dec 07 2021 at 22:02):
David Pyke (Dec 07 2021 at 22:03):
https://www.healthit.gov/cures/sites/default/files/cures/2020-03/TheONCCuresActFinalRule.pdf
David Pyke (Dec 07 2021 at 22:04):
There are many more under the Resources tab on that page
Craig McClendon (Dec 07 2021 at 23:40):
Appreciate the help @David Pyke . Perhaps I'm dense. The intent is very clear, but not the hard requirements.
Likely a dumb example - but suppose I develop a simple charting app for a local Mom & Pop doctors office who works on primarily on paper today. Would I be required to expose public FHIR APIs from that system for Patients to access? I'm not certain.
I was hoping to see something that plainly says 'if you meet criteria X,Y,Z; you MUST expose FHIR R4 USCDI APIs by this date. I feel like I'm missing something obvious.
Josh Mandel (Dec 07 2021 at 23:49):
If your charting app is a Certified EHR product or module, you'll need to pass all the test procedures at https://www.healthit.gov/topic/certification-ehrs/2015-edition-cures-update-test-method. But your "mom and pop" app won't be a Certified EHR without your deciding to make it one.
Last updated: Apr 12 2022 at 19:14 UTC
