Info Blocking

How does info blocking affect small practices?

By Meghan Franklin
April 7, 2021

Many large healthcare organizations, namely hospitals, have been preparing for the info blocking compliance deadline with a task force of representatives from their legal, information technology (IT), security, compliance, clinician and other teams.

What if, however, you are part of a small practice with no dedicated legal, IT, security or compliance team? What if you must wear not only the clinician hat, but also the chief information officer hat, general counsel hat and director of IT security hat? You’re likely feeling overwhelmed and perhaps underprepared to comply with yet another regulation.

Health care quality and IT expert Jessica Peterson, MD, MPH, wants small practices to know a few things:

  1. The info blocking compliance date has arrived. (If you missed it, it was April 5, 2021!)
  2. The goal of info blocking is not to increase barriers to care or burden providers
  3. It’s okay if you can’t deliver all requests for information in the way the requestor desires

Awareness is key

In her previous role as Manager of Quality and Health IT Policy at the American Academy of Ophthalmology, Dr. Peterson said her team worked hard to reach ophthalmology practices with information about the ONC Final Rule and info blocking requirements.

She said she knows other professional societies and organizations did and are doing the same—trying to ensure their member clinicians and practices are aware of the compliance deadline and what it means for them. During her outreach efforts, Dr. Peterson said she realized many practices were unaware of the info blocking rule and its requirements. “After the ONC Final Rule was published in March 2020, so many practices were buried and dealing with the impacts of COVID. People were doing their best to keep their heads above water in an extremely difficult time,” she said.

She understands how information about the ONC Final Rule could have been pushed aside as small practices had more pressing issues to deal with, like implementing telehealth or just keeping their doors open.

Today, as Vice President of Health Policy at MarsdenAdvisors, Dr. Peterson said one of her primary goals when working with practices is to ensure they are aware that the info blocking compliance date—April 5—has arrived.

Next, she helps them understand what compliance might look like for them, even if they don’t have advanced technological solutions and a massive (or any) IT department.

How can a small practice with limited resources comply?

While small practices with limited resources may not be able to fulfill every request for information in the manner the requestor desires, they can still comply with info blocking regulations.

They need to understand, however, which information blocking exceptions apply to their particular circumstances.

The Content and Manner Exception, for example, says, “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.”

The Content and Manner Exception could come into play for small practices, for example, if a patient requests that certain protected health information be transmitted to a third-party app, but the practice’s electronic medical record system doesn’t have an application programming interface (API) to make that transmission possible, or has limited data segmentation capabilities.

No matter how much the practice wants to deliver on the patient’s request, if they cannot do it in the manner in which the patient requests, they can claim the Content and Manner Exception and still be in compliance with the info blocking rule—provided a couple of other conditions are met.

If possible, the practice should fulfill the request in an alternative manner.

If a practice cannot fulfill the request in an alternative manner, perhaps because they have no ability to segment the data that is being requested, they could then claim the Infeasibility Exception. The Infeasibility Exception says, “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.”

If a practice can’t deliver the patient’s information in an alternative manner, the Infeasibility Exception says that they must provide a written response to the requestor within 10 business days of receipt of the request explaining why the request is infeasible.

Whatever the reason a practice cannot deliver on a request, Dr. Peterson said practices should have a procedure in place to deal with requests they cannot fulfill. She encourages practices to work with their EMR vendor to understand what they currently can and cannot do and then develop a strategy to deal with requests that fall outside of their current capabilities.

Ultimately, Dr. Peterson wants small practices to focus on a few things as they prepare to comply:

  1. Understanding what they currently are and are not capable of
  2. Understanding what alternative solutions to provide information are available to them
  3. Developing written policies for how to deal with situations in which an exception is required

Other considerations for small practices

Like another “Ask the Expert” participant, Craig Joseph, MD, shared, Dr. Peterson said she wants clinicians to be aware that patients will increasingly be reading their notes.

“This doesn’t mean that clinicians need to change the way they’ve been documenting for the past 30 years, necessarily,” Dr. Peterson said.

It does mean, however, that clinicians should be thinking about how their note could be misinterpreted by a patient.

For example, while using the phrase “Patient claims” in clinical documentation is common, Dr. Peterson said making a simple switch to “Patient states” may come across more favorably to the patient.

In addition to helping clinicians think about how they may want to tweak their documentation style, Dr. Peterson said she is working with practices to develop a glossary of commonly used terms they can share with patients to help with note interpretation.

“Clinical documentation is full of acronyms that may not make sense to non-clinician readers,” Dr. Peterson said. Providing a glossary of commonly used terms is one simple way practices can help bridge the gap between clinician documentation and patient understanding.

Dr. Peterson encourages small practices who may be feeling overwhelmed by the compliance deadline to keep one important thing in mind: “The goal of the info blocking regulation is not to place this huge burden on providers,” Dr. Peterson said. “They should feel confident that they can continue to focus on their main objective: providing the best possible care to their patients.”

About the expert: Jessica Peterson, MD, MPH is a health care quality and IT policy expert with a vision to reshape health care organizations and systems to make them more accessible and effective for patients, providers, and society. She is a leading expert on Medicare’s new Quality Payment Program and health IT policy and implementation, including 21st Century Cures information blocking and interoperability. She is currently Vice President of Health Policy at MarsdenAdvisors. You can read more of Dr. Peterson’s thoughts on the info blocking deadline at the MarsdenAdvisors blog.

About the writer: Meghan Franklin is a writer and strategic communicator with an M.A. in Rhetoric and a deep background in healthcare. As a former healthcare IT project manager and communications specialist at one of the nation’s leading children’s hospitals, she loves delving into healthcare topics. She values working with individuals and organizations on a mission to do something good.

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