Navigating Information Blocking: A Comprehensive Practice Guide

As Electronic Health Record (EHR) companies prepare for potential fines reaching up to $1 million regarding information blocking violations, healthcare practices and hospitals find themselves at the cusp of impending changes. Although no fines have been enforced for practices or hospitals yet, discussions regarding their imposition are actively underway.

One aspect that practices may need to adjust to is the immediate release of medical imaging and laboratory results to patient portals as soon as they become available, often preceding the physician’s opportunity to review and analyze them. This phenomenon is addressed under the Information Blocking Rule (IBR), with a particular focus on its Clinical Impact component.

The IBR dictates that clinical laboratories and medical imaging centers must provide patients with digital access to their test results. Similarly, in most cases, physicians’ EHR systems are expected to release results to patient portals without delay. This shift means that, in many instances, patients will have access to results before physicians can review, interpret, and communicate them to the patient.

However, it is essential to note that the IBR allows patients or their representatives to request a delay in the release of results, particularly for sensitive tests such as cancer screenings. Physicians can engage in discussions with patients about this option, providing additional time for result analysis and patient communication. The ability to offer this delay depends on the capabilities of the individual EHR system, as they may vary in this regard.

It is crucial to understand that the IBR does not mandate entities to notify patients when results are available or prompt them to review the results. Patients have the autonomy to choose whether to access their results immediately or delay their viewing.

Additional Resources on Information Blocking:

1. HIMSS offers a comprehensive resource that explains the 21st Century Cures Act, including information on information blocking and interoperability: https://www.himss.org/resources/21st-century-cures-act-part-two-information-blocking-and-interoperability
2. Direct access to the Information Blocking Rule is available here: https://www.healthit.gov/topic/information-blocking). An informative download outlining exceptions to information blocking is accessible via the above link.
3. Information Blocking CFR: https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-D/part-171/subpart-A/section-171.103. FR to the exceptions: https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-D/part-171/subpart-C.
4. OpenNotes provides valuable insights into the Information Blocking Federal Rule: https://www.opennotes.org/onc-federal-rule/
5. The OIG Final Ruling can be accessed here: https://oig.hhs.gov/reports-and-publications/featured-topics/information-blocking/#:~:text=The%20final%20rule%20establishes%20the,%241%20million%20penalty%20per%20violation
6. The Federal Register: https://www.federalregister.gov/documents/2023/07/03/2023-13851/grants-contracts-and-other-agreements-fraud-and-abuse-information-blocking-office-of-inspector

Policy Implementation Recommendations by TMC:

To navigate the evolving landscape of information blocking, TMC suggests the following steps:

1. Review and update your policies and procedures for fulfilling patient health information requests to ensure compliance with regulations, expedience, and consistency in handling electronic and physical information requests.
2. Develop a documented process for managing exceptions to information requests, aligning them with consent, privacy, and regulatory requirements. This process should encompass the eight exceptions mentioned here: https://www.healthit.gov/sites/default/files/cures/2020-03/InformationBlockingExceptions.pdf.
3. Create clear documentation for exceptions on a case-by-case basis for records management purposes. Consider developing templates for responding to requests that will not be honored, with reasons communicated transparently to the patient or their representative.
4. Establish a structured process for handling information blocking complaints. Ensure that patients are aware of how to file complaints using the provided resources, such as https://inquiry.healthit.gov/support/plugins/servlet/desk/portal/6.
5. Maintain documentation of any complaints or incidents related to information blocking for a minimum of six years.

TMC is committed to assisting you with any inquiries or concerns you may have. Please do not hesitate to reach out to Client Services or your consultant for further information and support.

By adhering to these guidelines and staying informed about information blocking regulations and potential violations, your practice can adapt effectively to the changing healthcare landscape.