Long-Term Care Organizations Achieve Interoperability, ADTs & Information Blocking via NJHIN

Recently, both the Department of Health of New Jersey and the Centers for Medicare and Medicaid Services (CMS) have made updates to legislation and regulation that impact connectivity, Admission, Discharge, and Transfer Notifications (ADT), and information blocking requirements for Long-Term Care Organizations. The New Jersey Health Information Network (NJHIN) can help Long-Term care organizations meet those requirements.  This article provides more detail and suggested next steps.

About the NJHIN

Along with meeting these new requirements, the NJHIN is being utilized to reduce medical errors, improve data quality, make healthcare more efficient and ultimately, improve patient outcomes for all New Jersey residents.

The NJ Department of Health (NJDOH) owns the NJHIN, and the New Jersey Innovation Institute (NJII) is the state designated entity assigned to manage it. Currently, all 71 acute-care hospitals, six health information exchanges (including regional health hubs), over 6,000 physicians, 91 long-term care providers, and 10 non-hospital facilities (Federally Qualified Health Centers, community clinics) have joined the NJHIN and are operating within its integrated network.

The NJHIN is the only network that has been built specifically to facilitate the exchange of patient data for all New Jersey patients with their healthcare providers. The NJHIN is unique in that it can connect directly to New Jersey’s public health registries, allowing it to maintain a statewide patient identifying system. The goal of this information sharing and increased interoperability is to reduce the cost of healthcare and improve patient health by leveraging the network for a variety of situations.

NJ Long-Term Care Emergency Operations Center (LTCEOC)

On September 16 2020, Governor Murphy signed Assembly Bill 4476 into law.

This piece of legislation establishes certain requirements concerning the State’s preparedness and response to infectious disease outbreaks, including the coronavirus disease 2019 (COVID-19) pandemic. One requirement that is established is the creation of the Long-Term Care Emergency Operations Center (LTCEOC) within the New Jersey Department of Health.

The LTCEOC shall serve as the centralized command and resource center for long-term care facility response efforts and communications during any hazardous event, including, but not limited to, infectious disease outbreaks, epidemics, pandemics, and all declared public health emergencies affecting or likely to affect one or more long-term care facilities.  The LTCEOC shall enhance and integrate with existing State, county, and local emergency response systems. 

One of the requirements that a long-term care organization must meet, is the connectivity to the New Jersey Health Information Network (NJHIN). The exact wording for the legislation can be found below:

26. a.  No later than 270 days after the effective date of this act, each long-term care facility shall implement or upgrade to an electronic health record system certified by the Office of the National Coordinator for Health Information Technology in the U.S. Department of Health and Human Services that is capable of information sharing through industry standard data interoperability, including application programming interface Health Level 7 or fast healthcare interoperability technology.  Use cases built on this technology shall include the bi-directional capability for admission discharge and transfer and continuity of care through the clinical data architecture.  Long-term care facilities interoperability for these use cases shall be achieved by connecting to the New Jersey Health Information Network.

b. Subject to the availability of funding for this purpose, the Department of Health shall make grants available to long-term care facilities to provide assistance in implementing or upgrading to an electronic health record system that meets the requirements of subsection a. of this section, which grants shall be distributed to long-term care facilities based on demonstrated need.

Assembly Bill 4476

Long-Term Care Organizations Meet CMS ADT Requirements via the NJHIN

While Long-Term Care Organizations are not specifically required to meet the following CMS requirements surrounding Admission, Discharge, and Transfer Notifications (ADT), the benefits that can be provided by joining the NJHIN can improve the treatment of their patients.

So far, 91 Long-term care providers have already joined the NJHIN and are sharing information throughout the state of New Jersey. Long-Term Care Organizations can join the NJHIN directly, or work with a Trusted Data Sharing Organization (TDSO) to participate in all of what the NJHIN has to offer. A TDSO can be a hospital, health system, or Health Information Exchange Organization (HIE/HIO) that is currently exchanging data with the NJHIN.

The federal government has put an emphasis on the ability to drive interoperability and patient access throughout the entire healthcare landscape. While Long-Term Care Organizations are not required to participate in ADT notifications, new federal regulations have required hospitals, including psychiatric hospitals and Critical Access Hospitals (CAHs) to do so. When Long-Term Care Organizations join the NJHIN, they are allowing for better quality and coordinated care for their patients.

Meeting CMS’s Requirements Outlined in the Final Rule

By participating and sharing data with the NJHIN, hospitals are meeting one of the key requirements of the Interoperability and Patient Access Final Rule published on March 9, 2020, by the Centers for Medicare and Medicaid Services (CMS). This rule focuses on driving interoperability and patient access to health information and establishes policies that enable better patient access to their health information, improve interoperability and unleash innovation, while reducing burden on payers and providers.

The rule outlines several key provisions related to Patient Access API, Provider Directory API, Payer-to-Payer Data Exchange, Public Reporting and Information Blocking, Digital Contact Information and Admission, Discharge, and Transfer (ADT) Event Notifications.

CMS has modified the Conditions of Participation (CoPs) and now requires hospitals, including psychiatric hospitals and Critical Access Hospitals (CAHs), to send electronic patient event notifications of a patient’s admission, discharge, and/or transfer to another healthcare facility or to another community provider or practitioner.

Subject to the patient’s approval, and in accordance with all state and federal laws, this requirement mandates that hospitals and CAHs demonstrate system capacity to share information on ADT Events to other provider. This is meant to provide coordinated care to everyone who will be caring for the patient, intermediaries that facilitate information exchange, and providers that are “primarily responsible for his or her care.”

Participation in the NJHIN Satisfies the ADT Notification Requirement

It is our interpretation, based on the language used in the final rule, that because the NJHIN does not impose any restrictions on recipients who want to receive ADT notifications, that any hospital or other entity that participates by contributing data is thus meeting the ADT requirement set forth by the CMS final rule.

NJII, as the state-appointed entity responsible for operating the NJHIN, congratulates our hospitals, health information exchanges, and non-hospital facilities for meeting this requirement ahead of schedule and making the ongoing effort to participate and share data with providers across the state.

Information Blocking

The Office of National Coordinator (ONC) has released the Cures Act, which outlines various requirements related to information blocking which may be confusing to health IT leaders. This rule affects patients, providers and Health IT developers. It promotes transparency into cost and outcomes, encourages improving patient access to their records and outlines requirements related to information blocking.

Healthcare providers (including long-term care organizations), health information networks, health information exchanges or a health IT developers can be an actor of information blocking. Information blocking is any activity that interferes with or limits access, exchange, or use of electronic health information (EHI).

The information and resources below will provide guidance in understanding the rules and regulation surrounding information blocking.

Information Blocking Practices

The Cures Act specifies certain practices that could constitute information blocking:

  • Practices that restrict authorized access, exchange, or use under applicable state or federal law of such information for treatment and other permitted purposes under such applicable law, including transitions between certified health information technologies (health IT);
  • Implementing health IT in nonstandard ways that are likely to substantially increase the complexity or burden of accessing, exchanging, or using EHI;
  • Implementing health IT in ways that are likely to— restrict the access, exchange, or use of EHI with respect to exporting complete information sets or in transitioning between health IT systems; or
  • Lead to fraud, waste, or abuse, or impede innovations and advancements in health information access, exchange, and use, including care delivery enabled by health IT.

Acceptable Exceptions

The rule also specifies a list of exceptions that are acceptable. Five exceptions involve not fulfilling requests to access, exchange, or use EHI.

  1. Preventing harm exception
  2. Privacy exception
  3. Security exception
  4. Infeasibility exception
  5. Health IT performance exception

Three exceptions involve procedures for fulfilling requests to access, exchange or use EHI.

  1. Licensing exception
  2. Costs exception
  3. Content and manner exception

NJII recommends that the healthcare stakeholder community carefully institute policies, procedures and workflows based on the examples and exceptions provided above.

For more detail, please visit the information blocking section of The Office of the National Coordinator for Health Information Technology (ONC) website or see the ONC publications on exceptions and information blocking actors.

Summary and Suggested Next Steps

NJII advises the Long-Term Care Organizations of New Jersey to participate in the NJHIN in order to satisfy the state’s requirements outlined in Assembly Bill 4476 which creates the Long-Term Care Emergency Operations Center (LTCEOC) and states “Use cases built on this technology shall include the bi-directional capability for admission discharge and transfer and continuity of care through the clinical data architecture.  Long-term care facilities interoperability for these use cases shall be achieved by connecting to the New Jersey Health Information Network.”

In addition, participation in the NJHIN will allow New Jersey Long-Term Care Organizations to align with CMS requirements surrounding ADT notifications and information blocking.

There is no cost for Long-Term Care Organizations to connect to the NJHIN and the services are 100% HIPAA compliant. No third-party providers are necessary. Organizations may connect directly or through their Health Information Exchange (HIE) or another trusted data sharing organization (TDSO).

Long-Term Care Organizations who wish to participate must have an EHR/EMR and at least one Medicaid patient, either managed care or secondary, in the billing year.

Any organization wishing to learn more about the NJHIN and how to connect is encouraged to contact us.