21st Century Cures Act, an Information Technology-Led Organizational Initiative.

Abstract

In 2020, as the COVID-19 pandemic was unfolding, an important portion of the 21st Century Cures Act (Cures Act), specifically the Open Notes Rule, was enacted [3,8,14]. Just as the Hospital for Special Surgery (HSS) information technology (IT) department was proud to support our institution’s heroic efforts to assist our community during the first surge of the COVID-19 pandemic [10], IT also played an essential role in the roll-out of this new regulation. Designed to improve care coordination and promote patients’ control over their own health information, the Open Notes Rule passed in May 2020 and went into effect in April 2021 [3]. Key to the goal of the Cures Act is its prohibition of “information blocking,” defined as a practice likely to “interfere with access, exchange, or use of electronic health information” [11]. The provision against information blocking applies not only to physicians, physical therapists, pharmacists, and hospitals but also to healthcare information networks and IT developers [1,12]. These regulations have required a shift in practice and also in attitude. Norms are changing: while continuing to secure confidential patient data, clinicians and health IT professionals are now also charged with sharing medical records with patients in near real-time. Enforcing these new rules is the Office of the National Coordinator for Health Information Technology (ONC), and financial penalties have been proposed for information blocking. In particular, physicians and other clinicians may be in violation of the information-blocking rule if they interfere with the exchange or use of electronic health information (EHI). The Interoperability and Patient Access rule is a separate but related rule that was also incorporated into recent changes to the EHI process at HSS. It requires the following 2 provisions [3]: • Provider directory. Providers must make their digital contact information available publicly in the National Plan and Provider Enumeration System (NPPES). This electronic directory includes the provider’s direct address (the equivalent of electronic health record e-mail address) and the hospital’s application program interface (API) endpoint. The API facilitates sharing of EHI using mobile applications such as Apple Health. • Event notifications. Hospitals must send notifications of inpatient admission, discharge, and transfer to primary care providers (and other providers the patient specifies). As a condition of hospital participation in Medicare, event notification will be monitored by state survey agencies and the Joint Commission.