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Episode 162: Workgroup Voices, The Inner Workings of Prior Authorization

April 12, 2023

Written by Samantha Holvey, Director of Workgroups & Communication

Are you feeling a bit lost in all the buzz around the Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing (HTI-1) proposed rule? Don't worry, we’ve got you covered. In this blog post, we break down some of the key components of this rule and why it matters to your organization.

Let's start with the basics. The HTI-1 proposed rule is a set of new regulations issued by the Department of Health and Human Services (HHS) that would impact primarily health care providers and software developers. The rule seeks to implement provisions of the 21st Century Cure Act by making it easier for providers to share information with each other, with the ultimate goal of improving patient care. The rule has three main components:

Certification Program Updates: The first part of the rule focuses on updates to the certification program for electronic health records (EHRs). The proposed updates would ensure that EHRs work more effectively and can more easily share information with other providers. Additionally, the proposed updates would require EHRs to be able to exchange additional types of health information, such as social determinants of health and clinical notes. This would provide a more complete picture of a patient's health and help providers make more informed decisions.

Algorithm Transparency: The second part of the rule is all about algorithm transparency. Algorithms, computer programs that can help health care providers make better decisions based on data, can be opaque, making it difficult for providers to understand how they work. The proposed rule would require greater transparency around algorithms, so providers can understand how they function and how they make decisions.

Information Sharing: The third part of the rule is focused on making it easier for providers to share information with each other. This is a critical component of improving patient care, as it would enable healthcare providers to coordinate care more effectively. The proposed rule would require providers to share information in a secure and safe manner, ensuring that patient information remains private and confidential. The rule seeks to make it easier for patients to access their own health information, empowering them to take a more active role in their care.

Many WEDI members play a critical role in implementing and maintaining HIT systems and infrastructure that will be required to comply with this proposed rule. They are responsible for ensuring that HIT systems are certified and interoperable, that APIs are implemented correctly, and that patient health information is secure and protected.

The proposed changes in the HTI-1 proposed rule reflect the ongoing evolution of health care technology and the increasing importance of interoperability and patient access to health information. By proposing these requirements, HHS is seeking to have health care facilities and their HIT professionals improve patient outcomes, reduce costs, and enhance the overall quality of care.

Feeling a bit soggy from the downpour of regulations this year? Subscribe to the WEDI Raining Regulations newsletter and we’ll keep you covered (link).

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