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#CuresNPRM tweetstorm time!

For context, the way "Information Blocking" provisions work is that electronic health information *must* flow for all permissible purposes, unless there's a good reason.

171.201-7 enumerate the possible good reasons information wouldn't flow

171.201 is the Good Reason to Block covering patient harm. Clearly, we wouldn't want to hurt the patient, yeah?

There are three subparts to 171.201 - (a)(1), (a)(2), (a)(3)
(a)(3) is simplest: on judgement of a licensed care professional, releasing data would cause direct harm & there is legally appropriate right to review by the patient.

Suicidal ideation, pattern of self-harm, overt threats etc are a Good Reason to Block. But very *rare*.

But (a)(1) & (a)(2), as written, are quite possibly loopholes broad enough to drive a dump truck through.

(a)(1) covers "Corrupt or inaccurate data" & (a)(2) covers "Misidentification of a patient or...EHI"

Let's cover these separately....

(a)(1), corrupt/inaccurate

There are very clearly cases where, due to a system bug, a record has total garbage. Small small minority of cases.

There are a much larger number of cases (approximating 100% of records), where there is *some* error.

If the standard for (a)(1) is any inaccuracy, that's a trivial standard to meet, and thus a trivial Good Reason to Block, if the standard is true data corruption, then rare...

The rule does not elucidate the standard (beyond policy guidance to minimize to prevent harm).

OK, (a)(2), "Misidentification" -- seems bad, right? Good Reason to Block, yeah?

But there seem to be no obligations here to stand up reasonable and appropriate patient identification practices, and no standard for what's reasonable here.

If the standard is 100% identification 100% of the time or Good Reason to Block, that's not an achievable standard. If the standard has no obligation to stand up reasonable and appropriate patient matching, it's trivial to meet the standard & Block

These are areas where commenters who are concerned about provider organizations wanting to hide behind Good Reasons to Block might want to propose reasonable standards that are rare in operational practice.

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