Sutter Health’s Anti-Information Blocking Compliance October 13, 2020

What is the Cures Act & Information Blocking Compliance?

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Office of the National Coordinator (ONC) for Health Information Technology announced the final rule of the 2016 Cures Act.

The new federal regulation acknowledges the important role patients play on their care teams by requiring healthcare providers to electronically release most clinical notes and test results to patients.

A practice by a health care provider, health IT developer, health information exchange, or health information network that, except as required by law or specified by the Secretary as a reasonable and necessary activity, is likely to interfere with access, exchange, or use of electronic health information.

This regulation applies to all authors of sharable note types, and care settings.

As of 11/02/2020, we will be held accountable for compliance with Federal Information Blocking regulations pertaining to data

classes within the US Core Data for Interoperability (USCDI).

By 05/02/2022 we will be held accountable for information blocking of ANY electronic health information.

What is information blocking?

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US Core Data For Interoperability

Vital Signs• Diastolic Blood Pressure• Systolic Blood Pressure• Body Height• Body Weight• Heart Rate• Respiratory Rate• Body Temperature• Pulse Oximetry• Inhaled Oxygen Concentration• BMI Percentile (2-20 Years) *NEW• Weight-for-length Percentile

(Birth - 36 Months) *NEW• Occipital-frontal Head Circumference

Percentile (Birth - 36 Months) *NEW

Care Team Members

Clinical Notes *NEW1. Consultation Note 2. Discharge Summary Note3. History & Physical4. Imaging Narrative5. Laboratory Report Narrative6. Pathology Report Narrative7. Procedure Note8. Progress Note

Goals

Health Concerns

Immunizations

Medications

Problems

Provenance *NEW• Author Time Stamp• Author Organization

Smoking StatusAllergies and Intolerances *NEW• Substance (Medication) • Substance (Drug Class) *NEW• Reaction *NEW

Assessment and Plan of Treatment

ProceduresLaboratory• Tests• Values/Results

Unique Device Identifier(s) for a Patient’s Implantable Device(s)

Patient Demographics• First Name• Last Name• Previous Name• Middle Name (incl. middle initial)• Suffix• Birth Sex• Date of Birth• Race• Ethnicity• Preferred Language• Current Address *NEW• Previous Address *NEW• Phone Number *NEW • Phone Number Type *NEW• Email Address *NEW

For more info:HealthIT.gov/USCDI

Graphic source: Office of the National Coordinator for Health IT

Information Blocking Exceptions

Exceptions that involve not fulfilling requests to access, exchange, or use electronic health information (EHI)

1. Preventing Harm Exception

2. Privacy Exception

3. Security Exception

4. Infeasibility Exception

5. Health IT Performance Exception

Exceptions that involve procedures for fulfilling requests to access, exchange, or use EHI

6. Content and Manner Exception

7. Fees Exception

8. Licensing Exception

Unless one of 8 exceptions apply, clinical notes must not be blocked.

For more info on Exceptions visit: https://www.healthit.gov/cures/sites/default/files/cures/2020-03/InformationBlockingExceptions.pdf

What does this mean for My Health Online?

By 11/2/20, we are required to make available clinical notes and

test results readily available to patients via MHO.

We plan to be in compliance by 10/29/20.

There is no opting out.

• Release 8 clinical note types• Includes notes pertaining to all patient care centers and

authors: acute & ambulatory, surgical, home health, e.g. • Historical notes will not be released immediately, but will

be available through existing HIM Release of information request

Open Notes

• Immediate release, Includes Lab and Imaging reports• No provision for delaying release or withholding results

unless release is prohibited by law• Historical cytology/pathology results will available for

manual release by clinicians

Results Release

What Information will be shared?

Notes SharingAs of 10/29/20, we will prospectively release all USCDI note types. These include: • Progress notes, • Procedure notes, • Care Team (multidisciplinary)• Telephone notes

All of these note types may be written by nursing in a variety of settings. We are not required to release “Nursing Notes” at this time. Sutter EHR Workflow to “block” a note in appendix!

What about nursing documentation?

Current state at Sutter Health:– Normal final test results released next day at 6am– Abnormal test results released 3 days later– California Sensitive Test Results are not released

As of 10/29/20, we will release normal and abnormal results immediately except those addressed in California Privacy Regulation. CA state law identifies 4 specific categories of “sensitive” test results which may be released online only after a healthcare professional [either the ordering provider or an authorized delegate] has first orally discussed the results with the patient:

1. HIV antibody test results (positive or negative), unless an HIV test subject is anonymously tested and posted without identifiers

Manual Release only

2. Presence of antigens indicating a hepatitis infection

Normal results release automatically; abnormal results will require manual release

3. Abusing the use of drugs.

Normal results release automatically; abnormal results will require manual release

4. Test results related to routinely processed tissues, including skin biopsies, Pap smear tests, products of conception, and bone marrow aspirations for morphological evaluation, if they reveal a malignancy.

Manual release only

Historical blocked CA Sensitive Results will not be automatically released but can be manually released by healthcare professionals.

What about Test Results?

Releasing Sensitive ResultsManually releasing / retracting sensitive results that patients do not want shared is available to both nurses, ancillary teams, and providers • Ambulatory nurses already release results and will continue on 10/29• Inpatient nurses currently do not release results

Workflow Recommendation• A new results release workflow will be available on 10/29 within the Sutter ehr• Inpatient nurses should not release results to the patient• The nurse will let the provider know if a patient requests sensitive results be released or

retracted• It is up to the provider or advanced clinician to go into the Results Activity and release or

retract the result

What do nurses need to know about Results Release?

Care Team Names• Release specific (first and last) Care Teams names (currently also available through HIM ROI)

What is available in MHO?• MHO does not show inpatient care teams names within the CareTeam section (only

ambulatory providers show today)• Inpatient Care team names will show within each progress, procedure, telephone and Care

Team note types and any electronic information that will be shared 10/29.• As a reminder, all electronic health information (EHI) by May 2022

MY CHART Bedside: • Care Team names are currently available• Planned expansion of My Chart Bedside across Sutter Health

Hot Topic: Care Team’s Names

• 9/10: Leader Email about Information Blocking regulation • 9/23: Take 5 messages to Managers and above: Federal Mandate Requires Release of Clinical notes and Test

Results to Patients• 9/25: All Sutter Provider (includes APCs) email from Bill Isenberg • 9/29: System Notice with Sutter ehr changes• 10/1: Planned: Labor Workforce Communications to Unions• 10/1-10/5: Planned: KDS communications to Nursing & Ancillary Teams• 10/12: All staff / provider communication re: Historical Notes

Where do I find………….• FAQ (your questions answered!)• Overview of Exceptions• Presentation Materials to share with colleagues• Clinician & Leader Messages • KDS & TIP Sheets for the new Sutter ehr tools • Coming soon:

– Patient FAQ links to share with patients

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Communications

LINK: Sutter Health's Open Notes and Results Release Resource Site

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Feedback…. and Questions

EMAIL US! clinicians@sutterhealth.org

APPENDIX

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Team Structure Steering Committee(Bi-Weekly)

Informatics

Proposed Focus Groups(Weekly)

SponsorBill Isenberg MD, Exec Sponsor

PacesettersDanielle Reno, MHA, PacesetterSteven Lane MD, PacesetterHoward Landa MD, Pacesetter

Jeremy HarrisKiren GuraiAmber BrownHilary Isacson

Howard Landa MDArthur Sorrell MDCharu Puri MDDonna WoelfelTim Nichols

Doug AngoveJoanna WashburnAdam Davis MDKaren WilliamsNithya Vijayaraghana

Jane SchulzeGary SweeneyMaisha Weary

Theresa MassieVince JocsonChristina SzetoJennifer Crow

Nancy TurnerBryan Gardner

Veena Jones, MDTom Mitchell

OGC/Privacy

Info Security

ISIntegration

HIMMHO/Open Notes

Bay/Valley Operations Marketing Communi-

cations

Kevin Chen, Mike ConroyKelvin LamAsh GokliPhysicians as needed

Project Management Pam Beeuwsaert – Project Manager

Compliance

Lisa Knowles

Focus Group LeadersVeena Jones MD, MHO/Open NotesAlbert Chan MD, VP Digital Patient ExperienceJane Schulze, HIMKevin Chen MD, Bay FoundationMike Conroy MD, Valley FoundationBryanna Gallaway, Patient ExperienceMary Schramke, Patient Family AdvisorNancy Turner, CommunicationsLisa Knowles, ComplianceKiren Gurai, OGC/Privacy Info SecurityJeremy Harris, OGC/Privacy Info SecurityDoug Angove, IS IntegrationSheli Page, IS ApplicationsTom Carlson, IS ApplicationsChristine Jensen, SHPDavid Nessim MD, SCCJulia Adler MD, Mental Health

Patient Experience

Bryanna GallawaySoumitra Gaopande(PFA)

SHP

Christine Jensen

OGC

Jeremy Harris

ISIntegration

Joanna Washburn

Informatics

Arthur Sorrell MDCharu Puri MD

Mental Health

Julia Adler MD

SCC

David Nessim MDCynthia Matsko

IS

Tom Carlson, Sheli Page

Doug AngoveJoanna Washburn

Clinicians will have the ability to block individual notes in the patient’s chart if they meet the very restrictive federal criteria for such blocking

Un-select the ‘Share w/ Patient’ button and document the reason for not sharing the note using the SmartPhrase (.MYNOTESHIDE) within the body of the note text.

• There will be a new system SmartPhrase (.MYNOTESHIDE) beginning 10/1.• Any notes that don’t have the new Smart Phrase will be automatically released to the patient on 10/29.

On 10/29, the Epic standard Notes ‘Button’ will be configured and defaulted to ‘Share Note’• Notes will be shared in MHO once completed* unless there is a specific exception applied to each individual

note, which the provider must document.*Outpatient – a note is ‘complete’ once encounter is closed

*Inpatient – a note is ‘complete’ once note is signed

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How to Block a Note