alphaspirit -

Best Practices to Fulfill the ONC Interoperability Rule

With a number of ONC interoperability rule compliance dates on the horizon, providers and health information exchanges will need to make some changes to adapt to these rules.

In March, the Office of the National Coordinator for Health Information Technology (ONC) released the interoperability rule as a part of the 21st Century Cures Act, primarily focusing on data exchange and patient information blocking.

Proposed in February 2019, the rule also supports patients accessing and sharing their electronic health information, which helps patients coordinate their healthcare.

The rule also prohibits information blocking and aims to hold health IT developers, such as EHR vendors, accountable as a condition of certification.

“Delivering interoperability actually gives patients the ability to manage their healthcare the same way they manage their finances, travel and every other component of their lives,” Don Rucker, MD, national coordinator for health information technology, said of the final rule. “This requires using modern computing standards and APIs that give patients access to their health information and give them the ability to use the tools they want to shop for and coordinate their own care on their smartphones.”

“A core part of the rule is patients’ control of their electronic health information which will drive a growing patient-facing healthcare IT economy and allow apps to provide patient-specific price and product transparency,” Rucker continued.

In order to comply with the rule, providers and health information exchanges will need to prepare accordingly.


Beginning on November 2, 2020, compliance is required for the information blocking provisions of the rule.

Information blocking is the intentional withholding of patient health information either from provider to provider or provider to patient. This has long been a touchy subject, with some industry experts questioning what exactly qualifies as “intentional.”

While the rule’s rollout coincides with COVID-19, providers may work with outside counsel to clarify parts of the rule in more detail to ensure compliance.

For example, to abide by the rules, Vanderbilt University Medical Center (VUMC) assembled a team to ensure compliance.

VUMC’s team has several representatives from different areas of expertise, such as patient experience, health information management (HIM), health IT, revenue cycle, legal affairs, and clinical operations.

Overall, the rules require providers to:

  • Provide patients with access to their medical record
  • Limit information blocking by sharing patient data with insurance companies, employers, and consumer-facing smartphone apps
  • Release nearly all lab, radiology and pathology results into the patient portal
  • Updating clinician information in federal databases

“The concept of Open Notes is not a new one for us at VUMC,” Paul Sternberg Jr., MD, chief patient experience officer and chief medical officer at VUMC said in a statement.

“In many ways, we’ve been simply waiting for the right moment to make it a reality for our patients. The release of the final rules has only accelerated our efforts and put some regulatory power behind them.”

Since the proposal occurred in early 2019, many providers were making strides to comply with the rules.

Providers are giving patients better access to their respective medical records, such as test results, and putting patients in control of their health data, through patient portals.

Health Information Exchanges

The interoperability rule focuses on making patient data more interoperable for patients, providers, payers, and virtually the whole healthcare ecosystem.

The ONC rule will require information to be more standardized, imposing terminology standards on the information’s meaning.

“We're going to focus on far less standard Consolidated-Clinical Document Architecture (CCDA) and more standard United Stated Core Data for Interoperability (USCDI),” Michael Gagnon, executive director for HealtHIE Nevada, explained to EHRIntelligence. “This is not only much more constrained, but it also includes labs that must be coded to LOINC and things like that.”

The rule also requires APIs to open up access to that information. It then clarifies to every provider organization that it must share this access, thus relieving the burden for HIE organizations.

“One of the burdens we've always had in Nevada is that providers needed to pay their EHR vendors a sizeable fee to effectively push their data to somebody else,” he explained. “They get more value out of the data coming to them and they get less value out of their data going to someone else.”

“Although they want to be good citizens, it's expensive to be a good citizen, and they're less incentivized to be one,” Gagnon continued. “The business practices part of the information blocking rule will be just as important as the technology parts of the information blocking role.”

HIEs need to play the role of the patient’s advocate or the patient’s service, thus eliminating the patient privacy risk.

“You come to us [the HIE], and we ensure that the data gets exposed to a particular app, but under conditions where it's still protected as a business associate,” he said. “I would create agreements with those organizations to make sure that patient data doesn't become freely available to everybody. It becomes used for the purpose it was intended for the patient's needs.”

HIEs contain patient data from all the different sources. Instead of providers having to create numerous open APIs or connections to various vendor applications, an HIE can help aggregate or consolidate data.

“We've struggled with having patient portals because a patient sees multiple providers then has multiple portals,” he continued. “It just becomes very inconvenient and very just fragmented for them, but the HIE could solve that problem.”

“I'm not saying I'm jumping into the portal market for patients yet, but I've always jumped into the market of being the aggregator of the information and pulling it together into a particular singular dataset for all of my participants. That role will just be expanded and enhanced with the new rules.”

Dig Deeper on Interoperability in healthcare

Cloud Computing
Mobile Computing