Govt. readies fight against EHR information blocking

The Office of the National Coordinator for Health IT (ONC) has submitted a report to Congress on information blocking, which prevents the sharing of patient information--a vital part of the national goal of seamless data sharing.

In a blog post about the report on ONC’s Health IT Buzz, National Coordinator Karen DeSalvo, MD, MPH, MSc, and Jodi Daniel, JD, MPH, director of ONC’s Office of Policy, said “The secure, appropriate, and efficient sharing of electronic health information is the foundation of an interoperable learning health system—one that uses information and technology to deliver better care, spend health dollars more wisely, and advance the health of everyone.”

The report examines allegations that some providers and developers are engaging in information blocking—knowingly and unreasonably interfere with the exchange or use of electronic health information. “Our report examines the known extent of information blocking, provides criteria for identifying and distinguishing it from other barriers to interoperability, and describes steps the federal government and the private sector can take to deter this conduct,” DeSalvo and Daniel wrote.

The report noted that ONC does not have the authority to regulate prices and that many of the actions in question do not violate laws. The agency wrote that it could decertify EHR systems that intentionally block data sharing but warned that doing so would wrongly penalize customers.

The report does not identify specific providers or developers but said ONC received 60 unsolicited complaints about potential information blocking in 2014 alone. “Some individual participants in the healthcare and health IT industries have strong incentives to exercise control over electronic health information in ways that unreasonably interfere with its exchange and use, including for patient care, DeSalvo and Daniel wrote, noting that these entities seek to control referrals and maintain market dominance.

“We are becoming increasingly concerned about these practices, which devalue taxpayer investments in health IT and are fundamentally incompatible with efforts to transform the nation’s health system.”

DeSalvo and Daniel said it is difficult to assess the extent of the information blocking problem “primarily because health IT developers impose contractual restrictions that prohibit customers from reporting or even discussing costs, restrictions and other relevant details.” They said they also fear that this behavior will become more prevalent as technology and the need to exchange electronic health information continue to evolve and mature.

The report includes several suggestions for ONC and other federal agencies to combat the problem:

• Propose new certification requirements that strengthen surveillance of certified health IT capabilities.
• Propose new transparency obligations for certified health IT developers that require disclosure of restrictions, limitations and additional types of costs associated with certified health IT capabilities.
• Specify a nationwide governance framework for health information exchange that establishes clear principles about business, technical, and organizational practices related to interoperability and information sharing.
• Work with the Centers for Medicare & Medicaid Services to coordinate healthcare payment incentives and leverage other market drivers to reward interoperability and exchange and discourage information blocking.
• Help federal and state law enforcement agencies identify and effectively investigate information blocking in cases where such conduct may violate existing federal or state laws.
• Work in concert with the Department of Health and Human Services’ Office for Civil Rights to improve stakeholder understanding of the HIPAA Privacy and Security standards related to information sharing.

DeSalvo and Daniel acknowledged that these actions aren’t enough to solve the information blocking problem. “Indeed, the most definitive finding of our report is that most information blocking is beyond the current reach of ONC or any other federal agency to effectively detect, investigate and address. Moreover, the ability of innovators and the private sector to overcome this problem is limited by a lack of transparency and other distortions in current health IT markets.”

Read the complete report.