July 1 deadline looms for healthcare provider compliance with OKSHINE

A doctor pulling up health information on a laptop

In 2021, SB574 created the Oklahoma State Health Information Network Exchange (OKSHINE). Last year, the Oklahoma Legislature passed SB 1369, expanding healthcare provider requirements to access and transmit certain types of patient information via OKSHINE. OKSHINE’s purpose is to enhance delivery in Oklahoma by providing timely access to a secure and trusted health information exchange (“HIE”) system while protecting patient privacy.

Beginning July 1, 2023, all healthcare providers licensed and located in Oklahoma must report data to and utilize MyHealth Access Network, Oklahoma’s state designated HIE entity. The Oklahoma Authority (OHCA) Office of the State Coordinator for HIE is charged with overseeing the implementation of the HIE, granting exemptions, and enforcing the requirements of the statute (and pending OHCA rules).

There two primary aspects of OKSHINE regarding provider implementation of MyHealth: utilization and transmission. Utilization requires healthcare providers to access patient medical records from the MyHealth portal and pay an annual subscription fee based on provider type and size. Transmission requires healthcare providers to pay MyHealth’s one-time connection fee and send patient data to MyHealth. OKSHINE requires providers to transmit any patient data considered “priority health information” to MyHealth, which medical professionals have defined as information necessary to effectively coordinate patient care.

According to the OHCA, “priority health information” will include the following:

  • Names of physicians and healthcare providers providing the patient’s care
  • Diagnoses
  • Current patient medications
  • Lab and x-ray results
  • Past procedures
  • Known allergies
  • Immunization records
  • Hospital discharge records
  • Basic personal information

Importantly, OKSHINE does not require healthcare providers to submit past patient data. Instead, providers must only transmit data originating from July 1, 2023, forward to the HIE through a MyHealth-compatible electronic medical record (“EMR”) system, as discussed below. Additionally, healthcare providers will be considered to have met the July 1, 2023, implementation deadline so long as they are actively engaged in MyHealth’s onboarding process to establish connection. Consistent with Health Insurance Portability and Accountability Act (HIPAA) standards, only those healthcare providers involved in a patient’s care are authorized to view that patient’s records, with their level of access depending on their respective scope of care. Additionally, patients may decide to prevent access to their medical records at any time by requesting that their provider mark certain health information or charts as “sensitive,” ensuring that such information will not be transmitted to MyHealth. Information of any type (behavioral or otherwise) that a provider marks as “sensitive”—along with care or services covered under 42 CFR Part 2—will be withheld from the MyHealth system. [1]

Cost

Many providers have expressed concern regarding the cost of OKSHINE implementation. MyHealth is already compatible and sharing data with many major EMR systems. Therefore, those healthcare providers already utilizing a MyHealth-compatible EMR should not incur additional costs in complying with OKSHINE. However, healthcare providers without an existing, compatible EMR will be responsible for costs associated with implementing a MyHealth-compatible EMR. Alternatively, these healthcare providers may contract directly with MyHealth by paying both a one-time connection fee and an annual subscription fee. According to the OHCA, this one-time connection fee is variable and depends on the provider’s system, but the estimated average is $5,000, payable at the time of implementation. Healthcare providers operating multiple clinics or hospitals may submit one MyHealth HIE application for each of these individual locations, and a single fee payment of $5,000 will cover each location’s respective employees. OHCA has not yet published a specific fee schedule regarding MyHealth’s annual subscription fee for HIE access.

Exemption

Under OKSHINE, OHCA may grant certain healthcare providers a full or partial exemption from OKSHINE’s utilization and transmission requirements. To be exempt from both MyHealth utilization and transmission, a healthcare provider must qualify for a broad-based exemption. Healthcare providers covered by a broad-based exemption will likely include the following:

  • Dieticians
  • Speech therapists
  • Occupational therapists
  • Physical therapists
  • Audiologists
  • Nurses (RNs and LPNs)
  • Other licensed, diagnostic, and non-prescribing healthcare providers (when working outside of a hospital, lab, home health, hospice, or nursing facility)

Additionally, healthcare providers who are retired, working in a free clinic, or working in an administrative, educational, or other non-patient treatment role may also qualify for a broad-based exemption from both MyHealth utilization and transmission. Healthcare providers covered by a broad-based exemption do not need to complete OHCA’s online exemption application form, but should be prepared to supply appropriate documentation showing they meet the exemption criteria upon request.

Healthcare providers who are ineligible for a broad-based exemption may apply for an exemption from MyHealth transmission based on financial or technological hardship, provider type, and/or size of practice. However, these healthcare providers must still utilize MyHealth by paying the annual subscription fee and accessing MyHealth records when providing patient care. It is important to note that OKSHINE exemption does not constitute an exemption from any other federal or state requirements for interoperability, or from the healthcare providers meeting their profession’s standard of care.

Provider compliance and July 1 deadline

To comply with OKSHINE, healthcare providers should ensure they are actively engaged in implementing MyHealth or a MyHealth-compatible EMR system by July 1, 2023. MyHealth is currently connected to more than 90 different EMR systems. Any system that meets the 2015 Cures Update for Certified Electronic Health Record Technology should already be MyHealth-compatible. [2]

If a healthcare provider believes they may be eligible for a broad-based exemption, they should still ensure that any information and records supporting exemption from OKSHINE requirements is readily accessible. Healthcare providers who may qualify for an exemption only from OKSHINE’s transmission requirements should promptly complete OHCA’s online exemption form, linked here. After reviewing healthcare provider exemption forms, OHCA will notify healthcare providers of their exemption status and any existing obligations under OKSHINE. OHCA will evaluate OKSHINE exemption criteria annually, indicating that healthcare providers—even if initially exempt—should continue to document any information pertaining to their exemption qualification.

If you have any questions, please don’t hesitate to contact your McAfee & Taft Healthcare attorney.


[1] 42 CFR Part 2 (commonly referred to as “Part 2”) contains the federal regulations limiting the use and disclosure of substance abuse treatment and prevention records and identifying information. Under Part 2, there are limited circumstances in which substance abuse patient information may be used or disclosed, and no other disclosures other than these detailed regulations are permitted. Generally, disclosure of a patient’s records requires written patient consent, which must contain certain elements and be narrowly tailored to limit disclosure to the specific parameters in the consent.

[2] Providers can determine whether their existing EMR system is MyHealth-compatible by searching for their EMR provider by name on the Certified Health IT Product List (“CHPL”) website, linked here. CHPL search results will indicate whether the EMR provider in question is certified under the 2015 Cures Update. Providers can also confirm an EMR system’s 2015 Cures Update certification by contacting the EMR provider’s technical support service directly.