Interoperability is among the highest priorities for health informatics as an industry. Defined as the ability of different systems to communicate with each other, share and make use of data, it’s essential to electronic health information exchange (HIE) reaching its full potential.
The goal isn’t shared by all players, though.
Information blocking is currently a major stumbling block to achieving interoperability. It occurs when an action is taken, most often by a vendor or provider, that interferes with the ability of electronic health records (EHR) to be shared.
There are legitimate reasons for information blocking, such as when a system’s security is suspect. Other motivations are more nefarious, such as when a vendor blocks access to coerce a healthcare organization into using a particular system or software.
Discerning the differences between legitimate and illegitimate blocking still is being worked out by the federal government, said Genevieve Morris, Principal Deputy National Coordinator at the Office of the National Coordinator for Health IT (ONC), in an interview with USF Health Online.
Blocking is understandable, Morris said, “if I don’t know that the provider I’m sharing the data with is following secure policies … I’m not going to want to share information with them.”
The 21st Century Cures Act, the wide-ranging healthcare legislation passed by Congress and signed into law in December 2016, sets parameters defining information blocking. It also imposes fines of as much as $1 million for vendors found guilty of this transgression.
What the Cures Act doesn’t do is define what information blocking isn’t — in other words, when a vendor or provider has a justifiable reason for withholding or limiting access to healthcare information. The Cures Act calls on the Department of Health and Human Services (HHS) and the ONC to determine what forms of the action are appropriate, with legislation expected in Spring 2018.
Still, even with this vital piece still to come, the Cures Act tightens definitions of information blocking and interoperability, and with its steep potential fines, makes clear the government’s commitment to the unbridled exchange of electronic health records.
The findings of a study titled “Information Blocking: Is It Occurring and What Policy Strategies Can Address It?” support the Cures Act’s prioritization of punishment for information blockers.
The study, published in health policy journal The Milbank Quarterly, found that “information blocking is reported to frequently occur among EHR vendors as well as hospitals and health systems, and that it is perceived to be motivated by opportunities for revenue gain.”
Half of the study’s respondents said EHR vendors regularly practice information blocking with the most common methods involving the distribution of products with limited interoperability, charging exorbitant fees for HIE and inhibiting third-party access to data. Financial gain and competitive advantage were the most common reasons for this.
The onus is on vendors and developers both to work directly “with physicians, hospitals, and with interoperability standards groups” to avoid issues with actual or perceived blocking, according to a post on The Health Care Blog.
When there are legitimate reasons for blocking, vendors and developers must explain these clearly and show that “the interest of their customers and their customers’ patients – not their own profits,” are what motivates the action, according to The Health Care Blog.