Prevent Information Blocking

The Information Blocking statute of the 21st Century CURES Act will go into effect April 5, 2021. This statute within this Federal Law requires providers, health information exchanges and networks, and health IT developers to not engage in “information blocking.”  This webpage is the place to go for the latest information tools and resources to provide you the information about how UMMS is complying with this new Federal Law and what it means to you.

FAQs

What is information blocking?

Information blocking includes anything that interferes with, prevents or discourages the access, exchange, or use of electronic health information, thereby improving patient access to their clinical data.

What changes are required by UMMS?

To ensure compliance with this Act, UMMS will make changes in Epic that will be effective April 1, 2021. After this date, in general, all clinical notes plus all laboratory, radiology and pathology reports will be automatically released to the patient via their MyPortfolio patient portal. Only case-by-case exceptions, as determined by the clinician, will be allowed.

What is the benefit of preventing information blocking?

This change in EPIC enhances UMMS current process of sharing information upon request and creates an opportunity to engage with our patients even more in their own care. It also advances our efforts to inform and educate our team members about patient rights regarding access to their medical records.

Prevent Information Blocking Webinar – March 24, 2021

Hear from experts across the System about how clinicians and team members can ensure they are in compliance with the new statute. You must be on the UMMS network or connected via VPN to view this webinar.

Clinical Resources

Resource Library

FAQs for Clinicians

No. Patients have had the right to request and view their entire medical record since 1970. When the Information Blocking Statute becomes effective on April 5, 2021, health care providers will be required to put into place electronic processes so that it is easier for patients to have access to their medical records as quickly as possible.

Yes. UMMS patients have had access to their entire medical record by requesting a copy of their medical records. In 2020, UMMS fulfilled at least 93,000 requests for medical records. Since 2016, all UMMS test results have been automatically released to patients via MyPortfolio. Test results are generally released as soon as they are resulted, but certain “sensitive” results are released after a lag of 3 days. Also since 2016, ambulatory practitioners have been able to share their notes via MyPortfolio. Making these notes and test results available to patients via MyPortfolio as quickly as possible is an important part of the Information Blocking Statute that goes into effect on April 5, 2021.

Traditionally, medical record request processes have certain barriers and delays. As of April 5, 2021, such practices will be deemed as “information blocking.” This will be unlawful and may result in penalties for the institution and the individual health care provider.

Yes. These changes will become effective on April 1, 2021 in Portfolio. Broadly, patients across all care areas (inpatient, outpatient, ED etc.) who have a MyPortfolio account will have access to components of their medical record as soon as they are completed. In general, notes written by all health care providers (attending physicians, residents, fellows, advanced practice providers, nurses, physical therapists, case managers, social workers, etc.) will be available to patients as soon as they have been signed (or as soon as they are co-signed if a co-signature has been requested). Unless specifically marked for a delay by the provider, laboratory results will be available to patients as soon as a final result is available in the medical record. Problem lists, medications and diagnosis will be available as soon as they are entered in the medical record.

No. Implementation of this statute does not change the existing state and federal privacy laws related to health care records for any patient groups. As a result, existing proxy settings in Epic MyPortfolio are not going to change.

Yes. Under the “preventing harm exception,” it will not be “Information Blocking” if a clinician engages in practices that are “reasonable and necessary to prevent harm to a patient or another person.” The threshold for determination of “harm” is relatively high, therefore the instances when this justification is used to block information from patients should be infrequent. Causing “stress or anxiety” to the patient does not qualify as “harm,” but risk to life or physical safety does qualify as “harm.”  For example, if reading a note is likely to increase the risk of suicide or homicide, this would be an appropriate reason for not sharing that note with the patient.

Beginning April 1, 2021, the button “Share w/ Patient ” in a note will be automatically checked. For note types that currently do not have this button (and are sharable via MyPortfolio), this button will appear on these notes on April 1, 2021. If a health care provider does not want a particular note to be shared, they would unclick this button. The provider should document the reason for blocking that particular note from the patient.

Click here to see screenshots of this functionality in MyPortfolio. Note: you need to be within the UMMS Network or logged into the UMMS VPN to view this example.

UMMS will run audits on blocked notes. When queried by UMMS compliance or by the governmental regulatory agencies, the provider should be able to justify the reason for not sharing a particular note with the patient.

No. The “preventing harm exception” is designed to cover only those practices that are “no broader than necessary” to reduce a risk of harm to the patient or another person. The decision of not releasing a note to prevent harm to the patient has to be made strictly on a case-by-case basis.

When queried by UMMS compliance or by the governmental regulatory agencies, the provider should be able to justify the reason not sharing a particular note with the patient.

Open Notes: Documentation Using a New Lens by Jill RachBeisel MD (PDF)

No. A blanket delay for the entire group of tests deemed sensitive will no longer be compliant with the law starting April 5, 2021.  For UMMS, starting on April 1, 2021, when a provider orders any test, the result will be defaulted to release immediately (as soon as results are available in Portfolio). This will be applicable in every care setting (ED, inpatient, outpatient). There will be an option of delaying the results on a case-by case basis (please see section below).

To make the patient aware of this possibility, results being released in MyPortfolio will include the following explanatory language: Test results are released to patients through MyPortfolio automatically. In some cases, the provider may not have reviewed them yet. Please be aware that reference ranges are guidelines and do not necessarily reflect an abnormal result for a particular patient. Please contact your provider if you have concerns.”

Click here to see a screenshot of this functionality in MyPortfolio Note: you need to be within the UMMS Network or logged into the UMMS VPN to view this example.

Yes. If a provider determines that immediate release of a test result will be harmful for the patient, it is reasonable to delay the release of test results in Epic. When a test is being ordered in Epic, additional options of “Immediate” or “release after 3 days” will be presented to the ordering provider.

No. At this time, components of medical records that have been finalized before April 1, 2021 will not be automatically released in MyPortfolio.

No, to provide the most accurate information to our patients, incomplete notes will not be released to patients’ MyPortfolio portal.

 The following are classified as incomplete notes:

  1. Pended Notes
  2. Notes for which the author has requested a co-signature, and the co-signature has not been completed.
  3. Notes that always require a co-signature, and a co-signature has not been completed (example: Admission H&Ps, consult notes, discharge summaries and ambulatory notes written by a resident physician).

If incomplete notes are being used to make health care decisions about an individual, then delaying the release of such notes may constitute “information blocking.” It is extremely important that notes awaiting co-signature should be co-signed and released in a timely manner.

All notes that are “sharable” via MyPortfolio will have a button “share w/ patient” associated with it.  If a healthcare provider determines that a particular note should not be shared (to prevent harm to the patient, another person or to protect the patent’s privacy), the provider should unclick the “share w/ patient” button.

No, harm refers to physical harm to a patient or another person. In mental health, if reading a note is likely to increase the risk of suicide or homicide, this would be considered appropriate to block his note.  Providers should always document the reason why a particular note was blocked from release.

The threshold for determining “patient harm” is high. For example, these conditions are not considered “harm”: “A patient may disagree with content, a patient may get angry, a patient may get confused, the therapeutic relationship may be harmed, and the patient may terminate treatment.”

Please refer to the ONC website for the exact definition of the exceptions.

Yes. There is no change to this needed to comply with the new Information Blocking regulations.

Yes, adult proxies have had full MyPortfolio access. Yes. There is no change to this needed to comply with the new Information Blocking regulations.

Yes. Starting on a child’s 12th birthday, parents with proxy accounts will only have very limited access to their child’s medical information to protect the confidentiality rights of the adolescent patient.

No, these are not parts of the patient’s legal medical record and will not be released to the patient’s MyPortfolio portal. However,  if any of these get copied into a “sharable note” (for example a progress notes), those will be viewable via MyPortfolio.

Yes. Even though we will be sharing more data with patients via their MyPortfolio patient portal, the completion of the Quick Disclosure process is still a requirement.  Under HIPAA, we continue to be mandated to track all disclosures from the patient’s medical record so that we can successfully complete an Accounting of Disclosures if requested.  To find the Quick Disclosure Tip Sheets,  please navigate to the UMMS Insider, enter “Portfolio Tip Sheet Library” into the Search Bar, and the Quick Disclosure Tip Sheets can be located under the “Clinical & Admin Support Staff” section of the Portfolio Tip Sheet Library.

No. Patients with a MyPortfolio account can request a copy of their medical records in one of two ways: either via their MyPortfolio account or through the Hospital HIM Department or respective Physician Office as they have always been able to do. All Third-Party requestors (i.e., attorneys, insurance companies, etc.) will continue to request records through the formal HIM process.

No. Although it will be easier and more timely to release an electronic copy of the requested records back to the patient via the patient portal, the patient has a right to request a copy of their records in whatever format or manner they wish (paper copies, flash drive, CD ROM, etc.).

No. The “sensitive” button is available when notes are being written in some specialties, for example, psychiatry. This button can be used by the health care provider who is writing the note to block other health care providers from accessing the note. This button does not control the release of that note to the patient’s own MyPortfolio portal. This functionality of the “sensitive” button is not changing on April 1, 2021.

If you need more information, or have questions, please contact the UMMS-Prevention of Information Blocking Group by clicking here or e-mail PreventInfoBlocking@umm.edu.

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