April 9, 2021
21st Century Cares Act: Unsharing Note to MyChart
As a reminder, the 21st Century Cures Act includes guidelines that require health care organizations across the country to ensure Electronic Health Information (EHI) is immediately available and released to patients through their MyChart account, or upon request. In addition, patients’ physicians, advanced practice providers (APPs), care teams and other authorized requestors, as designated per the Health Insurance Portability and Accountability Act (HIPAA) guidelines, also will have increased access to EHI to support the care they deliver to their patients.
We have received questions about the Information Blocking rules within the Cures Act, specifically regarding further clarification for when a physician or APP can choose to not share a patient note to MyChart.
The Information Blocking guidelines allow for five reasons to consider when determining if a note should be shared to the patient’s MyChart account or not:
1. Patient requested not to share note:
- Please record patient’s request within your documentation.
- Inform the patient this will only prevent the note from being seen in MyChart.
- A common scenario for using this reason would be when the patient has allowed proxy access to their MyChart and does not want the proxy to see the documentation.
2. If sharing a note is likely to cause physical harm:
Must be based on a reasonable belief that the practice of unsharing a note substantially reduces a risk of harm and the practice of unsharing the note is no broader than necessary, and is:
- An individualized finding made by someone with a relationship with the patient or based on data corruption issues.
- A type of harm-based withholding permitted under HIPAA (e.g., reasonably likely to endanger the life or physical safety of the individual or another person).
3. A note is a substance use disorder record:
Applies to Part 2 programs under 42 CFR Part 2. If you are unfamiliar with this terminology, most likely it does not apply to the unsharing a note exception within the Cures Act.
4. Documentation created for legal proceeding:
Information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding. See 45 CFR 164.524(a)(1)(ii).
5. Collateral information from non-provider:
The PHI was obtained by someone other than a health care provider (e.g., a family member of the individual) under a promise of confidentiality and providing access to the information would be reasonably likely to reveal the source of the information.
Please note that clinicians are not allowed to unshare a note if it does not meet one of the reasons listed above. Unsharing a note for any other reason than described above is Information Blocking, which is not allowed under the 21st Century Cures Act.
If you have questions about the 21st Century Cures Act, please contact your leader or visit CentraNet for resources including scripting, Q&As and FAQs.