HIE Survey: Labs Continue to Impede Data Exchange

More than one-third of health information exchange organizations (HIEs/HIOs) reported that laboratories have limited or refused to provide access, exchange, or use of electronic health information (EHI), according to a 2023 national survey.

 A recent data brief from the HHS Assistant Secretary for Technology Policy (ASTP) highlighted findings from the survey, but stopped short of characterizing the impediments as “information blocking” under the 21st Century Cures Act without further investigation. 

Among HIOs that experienced impediments in access to data by laboratories, about 1 in 5 indicated that they were not at all able to overcome these difficulties to access lab data, the data brief said.

Nearly 4 in 5 HIOs that experienced an issue with access to data reported that they were able to overcome difficulties due to lab impediments “to a small extent” (22%) or “somewhat” (57%).
Notably, no HIOs reported that they had been able to “fully” overcome these difficulties to access data from laboratories and only 4% reported being able to overcome these difficulties “to a great extent.”

Most HIOs reported that labs justified limiting or refusing to provide electronic health information because they do not derive value as a data contributor only.

Many labs also said that they are not obligated to engage in additional reporting after sharing results with the ordering provider, and some mentioned concerns about complex consent processes requiring multiple disclosure forms.

No HIO reported that labs sought to limit or refuse to provide access to data due to their concerns with HIOs’ ability to perform patient matching, and only 4% of HIOs reported that labs expressed concerns with producing duplicate data.

Over half of HIOs that reported impediments in access to data by labs cited two or more reasons labs used as a basis for limiting or refusing to provide EHI.

As the data brief makes clear, ensuring interoperability of laboratory data is a complex matter. Over 14 billion laboratory test results are ordered annually, and the flow of data cuts across many different entities and systems, and several health agencies are involved with its oversight.

ASTP noted that these survey results may not necessarily reflect acts of information blocking by laboratories under the 21st Century Cures Act, which generally prohibited information blocking. The law applies to healthcare providers (of which laboratories are included), health IT developers of certified health IT, and health information exchanges and networks (HIEs/HINs).

However, ASTP added that impediments in access to data by commercial laboratories are especially problematic because commercial laboratories are responsible for processing a very high volume of test results nationally, and thus their limited participation may greatly impact the completeness of HIOs’ laboratory data.

In a 2023 interview with Healthcare Innovation, health information organization Health Gorilla’s chief medical officer, Steven Lane, M.D., M.P.H.,  stressed that labs have been very slow to come on board, even though they are an actor under the information blocking prohibitions. "It's a little crusade of mine to try to help the labs understand that they need to come on board. All the labs are federally required to share data today, without delay, without special effort in the form and format that's been requested and they're just not doing it. If I need to get all of David's labs from every lab that has seen him in the last 10 years because I want to see his longitudinal lab record, that's not possible because people are literally breaking the law."