The 2019 Legislative Session saw the passage of Substitute Senate Bill 5380, which included a requirement that all health care facilities with ten or more prescribers excluding critical access hospitals, must fully integrate their Electronic Health Records (EHR) systems with the state’s Prescription Monitoring Program (PMP) or have obtained a waiver from the Department of Health (DOH). To be considered fully integrated, the EHR must be able to:

• Send information to the PMP without provider intervention;
• Allow current information from the PMP to be available to a provider within the workflow of their EHR; and,
• It must make the information available in such a way where it is unlikely to interfere with, prevent, or discourage access or use of electronic health information.

How Do I Comply?

The original effective date of this requirement was Jan. 1, 2021, however, Secretary of Health Dr. Umair Shah announced an extension of the date of compliance in response to the COVID-19 pandemic. By Jan. 1, 2022, health care facilities subject to the EHR/PMP integration requirement must be in compliance or have received a waiver of compliance issued by the DOH. The DOH has not yet completed the form providers will use to apply to receive a waiver of compliance. There are two ways to integrate an EHR with the PMP:

• The State’s Health Information Exchange, OneHealthPort (OHP); or,
• Approved direct integration options, such as Bamboo Health’s PMP Gateway (formerly Appriss Health).

What is the EHR/PMP Integration Waiver?

The DOH is currently in the process of creating the waiver form which will be available for those unable to integrate their EHR with the PMP, and the waiver will provide an exemption from the EHR/PMP integration requirement for the calendar year in which it is received by the DOH. Under the waiver rule, to qualify for the waiver the provider must be experiencing:

• Economic hardship of the following circumstances:
  • A bankruptcy in the previous year or a waiver submitted due to bankruptcy in the previous year;
  • Opening a new practice after Jan. 1, 2020;
  • Operating a low-income clinic, which is defined as a clinic serving a minimum of thirty percent Medicaid patients; or,
  • Intent to discontinue operating in Washington prior to Dec. 31, 2022.
• Technological limitations not reasonably in control of the provider, where the method of integration of the EHR and PMP is in the approval process by the DOH but is not yet completed.
• Other exceptional circumstances including:
  • Providing services as a free clinic;
  • The internet speed or bandwidth required for integration through a method approved by the DOH is not available;
  • The technology to connect the EHR of the provider through a method approved by the DOH does not exist;
  • Fewer than one hundred prescriptions for Schedule II-V drugs are generated in a calendar year; or,
  • Unforeseen circumstances that stress the provider or health care system in such a way that compliance is not possible. For example, natural disasters, widespread health care emergencies, unforeseeable barriers to e-prescribing, or unforeseen events that result in a statewide emergency.

An attestation for a waiver due to technological limitations or economic hardship may be submitted three times, giving a provider up to three years to come into compliance with the integration requirement. There is no limit to the number of exceptional circumstance waivers that a provider may submit.