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ONC Publishes Write-Back API Workshop Report

Last week, the Office of the National Coordinator for Health Information Technology (ONC) published its summary report of a virtual workshop held earlier this year to discuss stakeholder knowledge, current usage, potential use cases, and lessons learned on “write-back” API technology. In the EHR context, write-back APIs are those that can facilitate the exchange of data from an external source to an EHR using “write” processes, which encompasses the create, update, and delete aspects of create, read, update, and delete (CRUD) FHIR resource data for certain applications. The write processes can introduce functionalities to enable the EHR to process incoming data and store that information in a database.

The workshop came about late last year, with AMIA partnering with ONC to invite experts from across the health care, government, research, and financial technology (Fintech) industries to gather for the one-day virtual workshop, “A Policy and Technology Workshop on Write-Back APIs.” Workshop participants, which included numerous AMIA members, aimed to identify policy and technology barriers and opportunities for advancing availability of write-back APIs that enable “public-facing” third-party apps to populate EHRs. Participants observed that widespread adoption of write-back APIs outside of health care provide useful insights for the industry to consider in its policy and technology advancement activities for write-back APIs.

Further considerations identified by workshop participants included: additional workshops to further investigate and identify use cases and the related standards, policy, and regulatory factors that could provide a useful foundation for expansion efforts; Coordination with Standards Development Organizations (SDOs); and analysis of write-back privacy, security, policy, and regulatory considerations. A full accounting of conclusions can be found in the report here.


Medicare Telehealth Use Increase 63-Fold in 2020, According to New HHS Report

A new report from the Department of Health and Human Services (HHS) found that massive increases in the use of telehealth helped maintain some health care access during the COVID-19 pandemic, with behavioral health providers seeing the highest telehealth utilization relative to other providers. The report, which was produced by researchers in HHS's Office of the Assistant Secretary for Planning and Evaluation (ASPE), analyzes Medicare fee for service (FFS) data in 2019 and 2020. It found that telehealth services were accessed more in urban areas than rural communities, and that black Medicare beneficiaries were less likely than white beneficiaries to utilize the option.

As a whole, the ASPE report found the share of Medicare visits conducted through telehealth increased 63-fold, from approximately 840,000 in 2019 to 52.7 million through 2020. Further, while overall health care visits for Medicare beneficiaries declined in 2020 as compared to 2019, telehealth was helpful in offsetting potential foregone behavioral health care. In 2020, telehealth visits comprised a third of total visits to behavioral health specialists, compared to 8 percent of visits to primary care providers and 3 percent of visits to other specialists. The behavioral heath utilization numbers will likely remain high, as CMS recently finalized a rule authorizing payment for mental health visits furnished by Rural Health Clinics and Federally Qualified Health Centers via interactive video-based telehealth, including audio-only telephone calls. The entire ASPE report can be found here, and a CMS snapshot of the data can be found here.

OCR Continues HIPAA Right of Access Enforcement

The HHS Office of Civil Rights (OCR) announced last week that it had brought HIPAA-related enforcement actions against five more healthcare providers, bringing the total number of enforcements carried out under the agency's HIPAA Right of Access Initiative to 25. The Right of Access Initiative, which began in earnest in 2019, is intended to support individuals' ability to get their health records in a timely fashion at a reasonable cost, as HIPAA requires. Without an extension, a HIPAA-regulated entity must provide an individual or a representative with their records within 30 days of receiving a request.

Beginning under the Trump administration, the Right of Access Initiative has picked up steam in 2021, pursing over a dozen cases this year alone. In these latest five settlements, OCR underscored its focus on enforcing the HIPAA Privacy Rule's right of access standard, while levying civil monetary penalties in each case. “Timely access to your health records is a powerful tool in staying healthy, patient privacy and it is your right under law,” said OCR Director Lisa J. Pino in the agency's press release. “OCR will continue its enforcement actions by holding covered entities responsible for their HIPAA compliance and pursue civil money penalties for violations that are not addressed.”

Legislation & Politics

Bicameral Bill Hopes to Create CDC Office Of Rural Health

Rural health advocates are pushing Congress to pass legislation that would create a rural health office within the Centers for Disease Control and Prevention (CDC), calling it a long-term solution to address rural health disparities further exacerbated by COVID-19. The Rural Health Equity Act, as the Senate version of the bill is known, would create a CDC Office of Rural Health. The new office would be tasked with conducting, coordinating and disseminating research about issues impacting rural populations, including minorities and members of the LGBTQ community. It would also administer grants and contracts to develop and support policies aimed at improving health in rural areas.

Several CDC Morbidity and Mortality Weekly reports note that rural communities have a higher proportion of residents who are older, lack health insurance, and have existing comorbidities or disabilities. Rural residents also are at increased risk for COVID-19-associated morbidity and mortality, as they have limited access to health care facilities with intensive care capabilities. The legislation is backed by the Rural Health Action Alliance, which consists of the National Rural Health Association, the American Association of Nurse Anesthetists and, and the American Nurses Association, along with nine other organizations.

AMIA News & Notes

AMIA Offers Input on FDA Real-World Data Use for Regulatory Decision-Making

In comments submitted to the Food and Drug Administration (FDA), AMIA applauded the scientific rigor and thoughtfulness with which FDA approached its draft guidance, “Real-World Data: Assessing Electronic Health Records and Medical Claims Data To Support Regulatory Decision-Making for Drug and Biological Products Draft Guidance.” AMIA made several recommendations to clarify and improve the guidance, to ultimately further encourage industry to leverage Real-World Data. Read AMIA's full comments here.

AMIA Calls for National Data Enclave to Avoid ‘Data Discovery Divide'

In response to an NIH request for information (RFI) on search capabilities across the biomedical landscape for NIH-wide data discovery, AMIA called for the creation of a sustainable, national data enclave to allow organizations and researchers to build out pieces that will be relevant to them. Read AMIA's full comments here.

Around the Web

AMIA's Washington Download is your source for health informatics policy news and information from around the Beltway, covering action from the Hill, the Administration and important AMIA collaborators.