FEATURE
CURES ACT : INFORMATION BLOCKING OVERVIEW - CHALLENGES AND STRATEGIES
AUTHOR Thomas Dues , MD , FACP
THE CURES ACT : WHAT IS IT ?
The 21 st Century Cures Act was passed in December of 2016 and included requirements to analyze and direct resources to reduce clinician burden . 1 This large piece of legislation also included the goals of empowering patients ’ access to their health records and promoting health information interoperability . It prevents individual electronic medical record ( EMR ) and other clinical application vendors from actively shielding health information from other vendors and health information exchanges . 2 , 3 , 4 Tools to enable the unobstructed sharing of health data include patient portals as well as enhanced EMR data sharing for clinicians . 5
WHAT DOES THIS MEAN FOR HEALTH CARE PROVIDERS ?
Current regulatory requirements have pushed us to share data quickly with our patients . As a consequence , those practices and health care organizations with patient portals will ideally be sharing information immediately when completed or resulted in the EMR , unless unable to do so from an information technology ( IT ) or vendor capability standpoint , or if an applicable exception is documented . 6 This includes both inpatient and outpatient physician notes , laboratory and radiology results , and pathology reports , with important exceptions discussed below , regarding considerations of patient harm . 4
As the adoption of the patient portal has grown , the immediate availability of results and notes to patients has caused controversy . Papers and editorials from varied disciplines describe the disruption to clinical workflows and include case reports of angry patient telephone conversations and descriptions of patient anxiety . 7 , 8 , 9 Clinicians experience immediate and repeated pushback from patients without medical training , who are frightened or stunned by results learned without context or counseling . Patients often amplify this by searching out broad differential diagnoses on the internet . Many have already become accustomed to immediate access , so they also complain when their results are not instant . You may have already experienced all these things . Conversely , there ’ s also medical literature regarding increased patient and provider satisfaction . 10 We now are culturally accustomed to instant , convenient access to data , a technological advance that has improved our general knowledge and lifestyle .
CHALLENGES
The law poses serious challenges to practices because of immediate availability to potentially life-changing or confusing results . Confidential or sensitive information in clinical notes , not only those that are specifically excluded regarding psychotherapy , are challenging to address . Ask your patients : many patients choose not to have documentation of these discussions shared across a portal . Examples may include mental health evaluations and confidential discussions regarding potential abuse . 4 , 11 Adolescent records-sharing and proxy access is a topic that should be specifically addressed by policy , based on state regulations and involve compliance and legal counsel . 12
Successful strategies have been focused on patient and provider ( continued on page 26 ) NOVEMBER 2021 25