21st Century Cures Act and Information Blocking are Among the Topics Discussed at 2022 Health Information Technology Meeting

The Office of the National Coordinator for Health Information Technology (ONC), responsible for the advancement of national health information technology, held its annual meeting in February 2022 to share existing rules and emerging initiatives. The presentations this year were primarily focused on the 21st Century Cures Act, information blocking, and interoperability.

Here is what you need to know:

The 21st Century Cures Act

Officially enacted in May 2020, the patient is at the heart of the 21st Century Cures Act (Cures Act). The goal, quoting directly from the rule, is to “empower patients with their health record in a modern health IT economy.” With the patient at the center, the Cures Act encourages the patient to take charge of their healthcare. To do this, they need access to their EHI (or electronic health information) in an easy and inexpensive manner, perhaps from an app, and they need to be able to share their EHI with others.

Patients have always had access to their health data under the HIPAA Privacy Rule, but the Cures Act takes this one step further. Patients must be able to electronically access their information through patient portals, computer software and mobile applications. With the advancement in technology, the patient will be able to gather all their data from primary care physicians, specialists, pharmacies, hospitals, labs, health insurance company, and even gather information from their wearable devices.


Sharing information is the focus of interoperability. The challenge is to establish a platform that will read data from systems that have not been designed on similar frameworks. Therefore, interoperability focuses on establishing a common transport format, a common set of data to transport, a secure exchange protocol, and the ability for organizations to store a variety of data.

The common set of data has been defined under the Cures Act. This set of data elements is known as USCDI (United States Core Data for Interoperability). This subset of EHI, known as USCDI v1, is considered the most relevant data elements for sharing across healthcare entities. This core set of data establishes a minimum baseline of data for all healthcare exchange. EHR vendors are required to certify with an ONC-approved certifying body, with their capabilities to exchange version 1 information by the end of 2022. USCDI v2 has already been defined, adding additional data elements, and is anticipated to go into effect in 2023.

A common transport format and a secure exchange protocol have also been defined. Here are the main objectives:
  • The goal is to have EHR vendors implement this format by the end of 2022.
  • This foundation will not only be the transport between entities, but will serve as the foundation for patient-friendly applications.
  • This format, known as FHIR (Fast Healthcare Interoperability Resources), defines how information can be exchanged between different computer systems. FHIR, based on Health Level Seven (HL7), has become an international standard, which will only facilitate rapid growth in the interoperability world.

Health Information Exchange

Health Information Exchange (HIE) is commonly defined as the electronic transmission of healthcare-related data. It may also refer to an organization that is responsible for facilitating the exchange. Sharing information provides a more complete view of the patient, and reduces duplicate testing, treatments, and risk of error. Each organization can in turn provide better patient care.

At the time of a patient visit, a provider can access a patient’s records from all types of sources including:
  • A lab
  • A hospital
  • Another physician
  • The patient’s wearable devices.

Health Information Exchange can also assist in the monitoring of disease outbreaks, vaccine status for both children and adults, and other population trends. The majority of current HIEs are state, regional, or locally focused - collecting public health information or sharing information among regional and local facilities. However, work still needs to be done to connect these localized HIEs.

In mid-January 2022, ONC published the Trusted Exchange Framework, Common Agreement and QHIN (Qualified Health Information Networks) Technical Framework, commonly known as TEFCA. The goal of TEFCA is to establish a baseline of interoperability across the nation. Simultaneous with the TEFCA release, ONC also released the TEFCA FHIR Roadmap, outlining how TEFCA will promote FHIR adoption. Local, regional, and state HIEs will feed information to the QHIN. QHINs will exchange information with other QHINs. The hope is to see some QHINs before the end of 2022, with nationwide implementation by 2025.

We have long talked about nationwide healthcare connectivity and after the ONC annual meeting, it looks like it is on the not-too-distant horizon. Patient health data will be available at the push of the button to a patient, another provider, or a HIE. A patient who is travelling to another part of the country and becomes sick, will be able to provide their medical history and receive the care that is needed.

Stay tuned for more information on what you need to know to stay updated on regulatory and compliance topics that affect your independent practice or medical billing clients. For more information on Kareo, visit us at Kareo.com.

About the Author

Beth currently serves as an advisor to the Kareo EHR product and engineering teams for clinical enhancements, CMS Incentive program requirements, and other industry/...

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