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Dive Brief:

  • Regulators finalized an interoperability and technology rule on Thursday that aims to lessen administrative burden on providers, including through updates to prior authorization processes.
  • The Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology’s HTI-4 rule lays out new and updated health IT certification criteria for electronic prior authorization, electronic prescribing and real-time prescription benefit checks. 
  • The regulation should help clinicians spend less time on paperwork, the ASTP said. “We believe that this work will help patients and providers determine patient benefits at the point of care,” Dr. Thomas Keane, assistant secretary for technology policy and national coordinator for health IT, said during a press briefing Friday.

Dive Insight: 

The regulation, officially named the Health Data, Technology, and Interoperability: Electronic Prescribing, Real-Time Prescription Benefit and Electronic Prior Authorization final rule, should boost efficiency in the healthcare sector, saving $19 billion in labor cost savings over 10 years, regulators said in a fact sheet. 

It also comes on the heels of other moves by the Trump administration to reform prior authorization policies, where providers have to ask for approval from insurers before performing services or prescribing drugs. 

Clinicians argue the practices result in care delays that can ultimately harm patients. That comes on top of providers’ hefty burden of administrative work and other tasks in electronic health records, which clinicians say requires them to work overtime and contributes to burnout. 

To help automate some of this work, the HTI-4 rule adds and updates criteria for software to receive certification by regulators. The Health IT Certification Program is a voluntary program that outlines standards and functionality for health IT, like EHRs.

On prior authorization, the regulation adopts three new criteria: one that allows providers to request information from payers about coverage requirements, another that offers a method for clinicians and other EHR users to quickly collect the data needed for a prior authorization request, and a third that allows providers to submit requests through their IT systems and check the request’s status. 

The final prior authorization criteria are a little different than originally proposed, said Alex Baker, deputy director of the alignment and engagement division of the office of policy at ASTP. 

The proposed regulation, first announced last year, had only included one criterion that included all of the capabilities. But regulators broke them into three to provide more flexibility, allowing IT companies to certify products based on just one functionality instead, he said.

HTI-4 also adds new criteria for functionality for application programming interfaces, or APIs, linked to the prior authorization standard, including allowing workflow triggers in an EHR for clinical decision support tools. Another criteria allows users to be notified by a server of an event, like an update on a prior authorization request. 

Outside of prior authorization, the rule adopts a new criterion for real-time prescription benefit information, so providers and patients can easily compare drug prices, see out-of-pocket costs and check prior authorization requirements. 

Additionally, HTI-4 updates criteria for electronic prescribing, which enables prescription data to be shared between providers, pharmacies and payers.

The rule is part of a series of interoperability regulations released over the past couple years. HTI-4 includes some provisions from the HTI-2 proposed rule, which was first released in July last year. 

Other parts of the initial HTI-2 proposal were finalized in other regulations, including one published in December that focused on the Trusted Exchange Framework and Common Agreement, or TEFCA, and another on an information blocking exception that aimed to preserve access to reproductive healthcare.

The HTI-1 regulation, finalized in December 2023, is a sweeping rule that included transparency requirements for artificial intelligence in certified health software.