The Office of the National Coordinator for Health IT (ONC) released a report this week to Congress on health information blocking.
The report’s authors and researchers detailed several examples of electronic health record (EHR) developers and health systems blocking health information sharing between each other. The act of information blocking occurs when an entity or person knowingly and unreasonably interferes with the exchange of electronic health information. Examples of this are charging prices and fees for data exchange; creating terms of a contract that restrict individuals access to their health information; developing health IT in a non-standard way that dissuades information sharing; and developing health IT in a way that locks in information.
The report lists anecdotal evidence that suggests EHR application developers are breaking several of the rules in this regard. Using interviews with people at regional extension centers (RECs), the authors detailed complaints from industry sources on how developers are charging fees that make it cost-prohibitive to send, receive, or export electronic health information stored in EHRs. Some EHR developers even charge a substantial transaction fee any time a user sends, receives, or queries a patient’s electronic health information, the report says. The variation in prices reported to ONC suggests that some are taking advantage of the situation.
Moreover, complaints over information blocking usually come about because of contractual terms, technology design decisions, and other business practices. The report says many EHR developers purposely prohibit customers from selecting an ONC-certified health information service provider (HISP) of their choosing and use only the developer’s HISP. This is a problem because that prevents end users from meeting the technical requirements to exchange with other providers, the report says.
The report does not acquit providers from information blocking. It says that a common charge is that hospitals and health systems engage in information blocking to maintain their market dominance.
In a blog announcing the availability of the report, Karen DeSalvo, M.D. National Coordinator for Health IT, noted that evidence of information blocking is hard to analyze. “The full extent of the information blocking problem is difficult to assess, primarily because health IT developers impose contractual restrictions that prohibit customers from reporting or even discussing costs, restrictions, and other relevant details. Still, from the evidence available, it is readily apparent that some providers and developers are engaging in information blocking. And for reasons discussed in our report, this behavior may become more prevalent as technology and the need to exchange electronic health information continue to evolve and mature,” she writes.
The ONC report includes several suggestions to overcome information blocking. This includes proposing transparency obligations for health IT developers that require disclosure of restrictions and costs associated with interoperability, proposing certification requirements monitor health IT capabilities of applications, creating a governance framework for health information exchange that establishes principles on business, technical, and organizational practices related to interoperability and information sharing; and much more.
Moreover, the authors of the report and the ONC say that preventing information will require Congressional intervention. It does not specifically offer any suggestions though. The report came about after a request from Congress to produce a report on information blocking in healthcare and create a strategy to address it.
