E-prescribing, prior auth management part of new federal rule on health care EHR systems

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New federal rules governing electronic health data will enhance patient safety, reduce administrative burdens and streamline physician workflows, according to the American Medical Association (AMA).

The U.S. Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC) has published its latest directive, formally titled “Health Data, Technology, and Interoperability: Electronic Prescribing, Real-Time Prescription Benefit and Electronic Prior Authorization.” Abbreviated HTI-4, it becomes effective Oct. 1, 2025, with changes in store for electronic health record (EHR) systems in 2027 and 2028.

The new rule involves electronic prescribing (eRx), real-time prescription drug benefits and electronic prior authorizations (PAs).

“These updates enable improvements to workflow automation, reduce the manual effort required to conduct prior authorizations, improve operational workflow, and support more timely and transparent clinical decision-making,” said ASTP/ONC’s official fact sheet about the rule.

“We estimate these efficiencies will save millions of hours of clinician time annually, totaling $19 billion in labor cost savings over 10 years,” the fact sheet said. “In turn, that time savings can be used to spend more time with patients and less time on paperwork.”

A victory for health care

AMA claimed victory for advocating for technology programs and standards that will help physicians and patients. In a statement, AMA credited the leadership of Health and Human Services Secretary Robert F. Kennedy, Jr., for adopting “a single, modernized system designed to reduce medication errors, expedite prior authorization responses, and free physicians from outdated administrative tasks — freeing up more time for direct patient care.”

“This is exactly the kind of smart policy that emerges when physician experience with their patients informs government regulation,” AMA President Bobby Mukkamala, MD, said in the news release. “These upgrades will significantly reduce friction in the prescribing process, helping physicians deliver safer, faster, and more effective care of our patients.”

The changes also will be a step toward greater interoperability among physicians, other clinicians and in the U.S. health care system overall, said Tom Keane, assistant secretary for technology policy and national coordinator for health IT, and Steven Posnack, principal deputy assistant secretary for technology policy and principal deputy national coordinator for health information technology.

“Through ongoing collaboration and coordination with CMS, we are committed to advancing interoperability for patients, health care providers, and payers to ease administrative burdens,” they said in a blog post explaining the rule. “This final rule is a critical step in these efforts.”

Electronic prescribing

ASTP/ONC and AMA described provisions of the new HTI-4 rule.

The “electronic prescribing” criterion is updated to enable the exchange of prescription information among prescribers, pharmacies, intermediaries and payers, the fact sheet said.

Health IT systems that use it also must meet a new “real-time prescription benefit” that enables access to prescription drug information that physicians, other clinicians and patients can use to compare costs of drugs and suitable alternatives.

Health IT system administrators must comply by 2028, the same compliance deadline as the U.S. Centers for Medicare & Medicaid Services. Old eRx services will be retired at that time, a move that “gives physicians and electronic health record developers a clear, synchronized roadmap, eliminating the risk of dueling federal timelines,” according to AMA. The association supported all those changes.

“Electronic prescribing has improved health care efficiency and patient safety,” Mukkamala said in the news release. “We need to continuously update the regulations to make sure we are taking advantage of the quickly advancing technology while removing the clutter of earlier regulations. HHS and the AMA have done just that.”

Prior authorizations

The HTI-4 final rule has three new certification criteria that aim to improve efficiency of prior authorization, while reducing administrative burdens. ASTP/ONC said the changes:

• Enable health care providers to request information from payers about coverage requirements.
• Provide a mechanism for clinicians and other EHR users to navigate and quickly assemble the information needed to support PA requests according to payer requirements.
• Allow submission of PA requests from health IT systems, with ability to check the status of earlier requests.

“Together, these changes mark a major step toward true interoperability of critical patient records, enabling physicians to access and exchange essential information more seamlessly across the care continuum,” the AMA statement said.