21st Century Cures Act

On May 1, 2020, the Office of the National Coordinator for Health IT (ONC) published the final rule in the Federal Register.

• The rule establishes interoperability requirements that promote innovation in patient data delivery and prevents information blocking.  
• The rule requires providers, health information exchanges and networks, and health IT developers to not engage in knowingly interfering with the access, exchange, or use of electronic health information.  

The goal is to promote transparency and provide visibility into services, quality and costs of healthcare.

As a physician, the most direct impact to you is that your patients will now see their results and clinical notes immediately to comply with the rule, ensuring that healthcare systems are not knowingly interfering with the access, exchange or use of electronic health information.  

Among the many overarching goals of the rule is that patients now have the right to access all their clinical data that is part of the USCDI standard. Outside organizations may also request connections for clinical data exchange with Beaumont to promote health interoperability. 

The exceptions for denying patients their Personal Health Information (PHI) are very narrow in scope and can only be used in specific exceptions. 

In an ambulatory setting, once in-office results are marked final, they will be immediately released to the patient’s myBeaumontChart. 

The goal of this rule is to further promote transparency and ease of access to their records. 

To meet this goal we must:

• expand clinical notes available within myBeaumontChart
• immediately release notes, upon signing
• immediately release results, upon final result
• expand Teen-Full proxy access to include all components of the patient’s chart

What if releasing the results and/or notes would cause danger to a patient’s life or physical safety? 

• Results:  A question will be available for those sensitive orders [diagnostic imagining, surgical pathology and cytology] that will allow you to delay. 
• Notes:  Notes are set to release by default. If you, as a clinician, think that it will cause danger to a patient’s life or physical safety, you may unselect the option to release. You will be required to document with the specific reason as to why you think this would cause danger to a patient’s life or physical safety and must be prepared to defend your decision.   

What if I’m concerned about patients harming themselves upon seeing the results before I have a chance to contact them? 

• Delaying results release may be allowed in a very limited circumstance if the physician believes it will substantially reduce the risk of harm to the life or physical safety of the patient. 
• When the patient meets the exception criteria to allow for the delay in releasing the results, a question will be added to those sensitive orders [diagnostic imagining, surgical pathology and cytology].  At the time of ordering, these sensitive orders use the additional field in the ordering window that will allow for the current standard delay of the results based upon the current delay release [diagnostic imaging 5 day delay and surgical pathology/cytology 3 day delay] 
• Anxiety or psychological reasons are not part of the allowed reasons. 

Healthcare providers that are found in violation of the rule might have appropriate future CMS incentives denied from them. (i.e. interruption of QPP incentives from CMS). 

Health IT developers of certified Health IT, Health Information Networks and Health Information Exchange that are found in violation of the rule will have civil monetary penalties of up to $1 million per violation. 

This first part of this rule will go into effect on Monday, Nov. 2.  

Beaumont will be making most of the required changes on Tuesday, Oct. 20 in preparation for the effective date. 

OVERVIEW

While Beaumont is releasing results to patients, there have been some delays in delivering test results to patients. To meet the information blocking rule requirements, all lab results will be released immediately to patients through myBeaumontChart.

What if I’m concerned about patients harming themselves upon seeing the results before I have a chance to contact them? 

• Delaying results release may be allowed in a very limited circumstance if the physician believes it will substantially reduce the risk of harm to the life or physical safety of the patient. 
• When the patient meets the exception criteria to allow for the delay in releasing the results, a question will be added to those sensitive orders [diagnostic imagining, surgical pathology and cytology]. At the time of ordering, these sensitive orders use the additional field in the ordering window that will allow for the current standard delay of the results based upon the current delay release [diagnostic imaging 5 day delay and surgical pathology/cytology 3 day delay]
• Anxiety or psychological reasons are not part of the allowed reasons.

Tests which will have the option to be delayed if the provider, at the time of ordering, indicates that it should be delayed and the exception reason:

(Click on the table above to see the full list of tests)

CHANGES

Which clinical note types will be released to patient’s myBeaumontChart?   

Patients can continue to ask for a full copy of their medical record through HIM, as they’ve always done. The following list is not all inclusive, as there are ongoing discussions:

For those note types being released with Open Notes, has Beaumont been meeting the threshold of note release required to meet the 21st Century Cures Act requirement?

No, only 60% of inpatient notes and 54% of ambulatory notes have been released. With the 21^st Century Rule, all notes that are included in scope must be released immediately to the patient. 

What if releasing the results and/or notes might cause the patient anxiety or distress? 

Feedback from ONC and HIPAA specifically states that Electronic Health Information (EHI) cannot be denied to the patient’s individual access because of general concerns regarding psychological or emotional harm. The only exception allowed is if the release of EHI would cause danger to the patient’s life or physical safety. 

What if releasing the results and/or notes would cause danger to a patient’s life or physical safety? 

Results: A question will be available for those sensitive orders [diagnostic imagining, surgical pathology and cytology] that will allow you to delay. 

Notes:  Notes are set to release by default. If you, as a clinician, think that it will cause danger to a patient’s life or physical safety, you may unselect the option to release. You will be required to document with the specific reason as to why you think this would cause danger to a patient’s life or physical safety and must be prepared to defend your decision.  

What if I feel threatened that there is a danger to me, as a clinician, if I release the note to the patients myBeaumontchart? 

If it is felt that there is danger to your own safety by releasing a note, please make a report with either Beaumont security or the police and document accordingly in the note utilizing the smartphrase: BH REASONS NOT TO SHARE NOTE

‘This note was not shared with the patient because access to information in the note is reasonably likely to endanger the life of physical safety of a Beaumont Workforce member or another person.  A report to Beaumont Security or the police has been made.’

As of October 20^th, only the following will display a full last name within the patient’s myBeaumontChart.  All other roles will display first name and first initial of the last name. Note: There are not any changes to name display with the release of the full legal medical record by the HIM department.

Care Team members will now display in myBeaumontChart.  Ambulatory providers with an established relationship are automatically added to the Care Team or manually added during an office visit.

As of October 20^th, only the following will display a full last name within the patient’s myBeaumontChart.  All other roles will display first name and first initial of the last name. Note: There are not any changes to name display with the release of the full legal medical record by the HIM department.

There will not be any change to clinical information shared when the parent has Teen-Limited Proxy Access.  If a provider provides a parent Full-Teen Proxy Access, all clinical information will be shared within myBeaumontChart. 

Upcoming webinars will be held on the following dates:

• Monday, Sept. 28 at 12 p.m.
• Wednesday, Sept. 30 at 5 p.m.
• Tuesday, Oct. 6 at 7 a.m.
• Thursday, Oct. 8 at 5 p.m.
• Monday, Oct. 12 at 5 p.m.
• Wednesday, Oct. 14 at 12 p.m.
• Friday, Oct. 16 at 12 p.m.
• Tuesday, Oct. 20 at 5 p.m.
• Thursday, Oct. 22 at 8 a.m.

View the 21st CCA Webinars for more information.

If you are unable to attend one of the upcoming webinars, please view a video recording in the Epic/oneChart video library.

• Information Blocking 
• Federal Register