21st Century Cures Act: Interoperability and Information Blocking

What is the 21st Century Cures Act?

The 21st Century Cures Act is a bipartisan health care law that promotes innovation in the health care technology ecosystem to deliver better information, more conveniently, to patients and clinicians. It also promotes transparency, using technology, to provide opportunities for the public to gain visibility in the services, quality, and costs of health care.

It includes requirements that promote health information interoperability and prohibit information blocking by health information networks, HIEs, technology developers of certified health IT, physicians and other health care providers.

The Office of the National Coordinator for Health Information Technology (ONC) released a final rule, 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program in May 2020.

Read Information-Blocking Articles

Final Rule

• ONC's Cures Act Final Rule

• CMS Interoperability and Patient Access final rule

What is electronic health information (EHI)?

EHI is defined as the electronic protected health information (ePHI) in a designated record set (as defined in the Health Insurance Portability and Accountability Act (HIPAA) regulations) regardless of whether the records are used or maintained by or for a covered entity.

Who are the “actors” covered by information blocking?

• Physicians and Other Health Care Providers
• Health Information Networks (HIN)/Health Information Exchanges (HIE)
• Health IT Developer of Certified Health IT

When do I have to comply with the information blocking requirement?

• Actors have been subject to the information blocking rule since April 5, 2021. You are already required to share EHI if you participate in the Promoting Interoperability of the Merit-Based Incentive Payment System (MIPS) program.

What EHI must be shared?

The information blocking provisions require that patients and their physicians be given immediate electronic access to significant portions of the patient’s EHI upon request, unless an exception applies. This includes the information detailed in the United States Core Data for Interoperability (USCDI) version 1 data set and does include clinical notes and specifies eight note types:

• Discharge summaries
• History and physicals
• Progress notes
• Consult notes
• Imaging reports
• Laboratory reports
• Pathology reports
• Procedure notes

I don't use an Electronic Health Record (EHR). Does this mean I have to get one?

The requirements of the 21st Century Cures Act only applies to electronic patient health information. If you are using paper records, it will not apply to you. There is no mandate for you to move to an EHR.

Can I charge for releasing patient medical records electronically?

It depends. Read the details in the following member resources.

• 21st Century Cures Act White Paper (March 2021)
• White paper resource: Fees for Copies of Medical Records

Resources

• • Interoperability and Patient Access Fact Sheet (CMS)
  • The Information Blocking Resource Center (Infoblockingcenter.org)
  • What Does the Rule Mean for Physicians?
  • TMA HIPAA Resource Center
  • TMA Health Information Exchange Resource Center

Advocacy

• TMA Comment Letter to the ONC Re: USCDI v2 (April 15, 2021)

• TMA’s Comments to the ONC on the 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program (June 3, 2019)

• TMA Comment Letter to CMS on Interoperability and Patient Access (June 3, 2019)

• AMA Summary of ONC Final Rule on Electronic Health Information Blocking, Interoperability and the Cert Program