Given the speed and relative ease with which information flows these days, you’d think that physicians would be able to talk to each other about a patient without much ado. There are many roadblocks on the health information highway, however, according to a report to Congress released Friday by The Office of the National Coordinator for Health Information Technology (ONC).
The report, produced in response to a request from Congress for a closer look at the issue of health information blocking, closely examines the ways in which health information is shared, and sometimes blocked, by healthcare providers, EHR vendors, and other stakeholders.
The ONC defines health information blocking as a knowing and unreasonable interference with the exchange or use of electronic health information. There are a number of reasons why a person or entity might intentionally or unintentionally impede the exchange of health information. Patient privacy and safety are perhaps the most prominent issues; but the report raises concerns about prohibitive fees from EHR vendors for information exchange, legislation that might need clarification, and competition – whether between vendors or providers.
INCENTIVES HAVE ENCOURAGED ADOPTION
Financial incentives to providers have encouraged EHR adoption. Those incentives help to offset some of the $15,000-$70,000 costs of purchasing and implementing EHR systems. Time spent by providers learning to effectively use new systems is more difficult to quantify. Additionally, new IT staff are required to support the EHR, and there are ongoing licensing and maintenance agreements that eat into provider earnings. Despite these issues,
over three-quarters of eligible providers and 9 in 10 eligible hospitals have received incentive payments for adopting and meaningfully using certified health IT,
according to the ONC report.
BUT THE INFORMATION DOESN’T FLOW FREELY
The issue brought to Congress is that, given the rate of EHR adoption and use, there are still many obstacles to “secure, appropriate, and efficient sharing of electronic health information.” The ONC received more than 60 unsolicited complaints of information blocking in 2014. This figure does not account for the numerous anecdotal accounts of information blocking in public testimony, industry analyses, and news media.
In a press conference, Dr. Karen DeSalvo, the National Coordinator for Health Information Technology, told nuviun and other media representatives that the ONC report isn’t about whistle blowing.
“There’s not a lot of quantified information right now, but we feel confident that [the issue of information blocking] requires better definition.”
3 ROADBLOCKS TO INFORMATION SHARING
While no whistles were blown, three common culprits of information blocking were identified.
1. Health IT Developers
Developers are taking most of the grief here, as there is a wide variation in the fees they charge for their products and services. Some of the variation can be explained by differences in the costs of technology architectures and service capabilities, and the discrepancies in how developers pass along those costs to customers.
According to complaints heard by the ONC, certain health IT developers make it cost-prohibitive to send or receive the electronic information stored in EHRs. Some charge fees each time a user sends, receives, or searches for patient health information. Others use proprietary data formats or fail to publish application-programming interfaces (APIs) that prevent information exchange between providers using different platforms.
2. Healthcare Providers
Hospitals and health systems are other commonly named sources of information blocking. Complaints have been made that certain providers knowingly and unreasonably interfere with the exchange of electronic health information as a way of “controlling referrals and enhancing their market dominance,” according to the ONC report.
Some providers have rules in place concerning their methods of information sharing that the ONC would consider information blocking practices. For example, a hospital may only share information with outside providers via fax, which is time consuming and cost-prohibitive, delaying the timely receipt of information and requiring manual input by the receiving hospital.
3. Non-Standardized Processes
As providers implement EHRs in their institutions, some do so in non-standard ways that add complexity, increase costs, and impede interoperability. This may result from good intentions, such as concerns for patient privacy. The ONC report states:
It has been reported to ONC that privacy and security laws are cited in circumstances in which they do not in fact impose restrictions.
A CALL FOR TRANSPARENCY AND ACCOUNTABILITY
The ONC report calls for transparency and accountability, along with increased investigation and enforcement of information blocking. I’ll have more details later this week as they emerge in discussions at the annual Healthcare Information and Management Systems Society (HIMSS) conference in Chicago, where Dr. DeSalvo is a keynote speaker.