The Problems with Information Blocking in Healthcare
By: Natalie Cheng
What is information blocking in healthcare and why is it hurting health systems? According to HealthIT.gov, information blocking is “a practice by a health IT developer of certified health IT, health information network, health information exchange, or health care provider that, except as required by law or specified by the Secretary of Health and Human Services (HHS) as a reasonable and necessary activity, is likely to interfere with access, exchange, or use of electronic health information (EHI).” What practices are considered information blocking? According to the American Medical Association, information blocking practices include:
1. Practices that restrict authorized access, exchange, or use under applicable state or federal law of such information for treatment and other permitted purposes under such applicable law;
2. Implementing health IT in nonstandard ways that are likely to substantially increase the complexity or burden of accessing, exchanging, or using EHI;
3. Limiting or restricting the interoperability of health IT, such as disabling or restricting the use of a capability that enables sharing EHI with users of other systems or restricting access to EHI by certain types of persons or purposes that are legally permissible, or refusing to register a software application that enables patient access to their EHI (assuming there is not a legitimate security reason that meets the conditions of the Security Exception, discussed further below);
4. Implementing health IT in ways that are likely to restrict the access, exchange, or use of EHI with respect to exporting complete information sets or in transitioning between health IT systems. This would include acts that make transitions between certified health information technologies more challenging (e.g., an EHR vendor charging excessive fees or using tactics to delay a practice’s switch from their EHR to another vendor’s EHR);
5. Acts that lead to fraud, waste, or abuse, or impede innovations and advancements in health information access, exchange, and use, including care delivery enabled by health IT;
6. Restrictions on access, exchange, and use, such as may be expressed in contracts, license terms, EHI sharing policies, organizational policies or procedures or other instruments or documents that set forth requirements related to EHI or health IT, such as Business Associate Agreements (BAAs); and
7. Rent-seeking (e.g., gaining larger profits by manipulating economic conditions) or other opportunistic pricing practices.
Problems with Information Blocking
Did you know that 55% of healthcare information exchanges (HIE) say that they sometimes or often observe instances of refusal? Did you know that 37% of HIEs also said that health systems sometimes or often use artificial barriers to limit access, exchange, or use of electronic health information?
Information blocking can cause many problems in healthcare organizations. Think about it. As a clinician, when you are seeing a patient that has been transferred to your hospital, how would you know how to properly treat the patient and provide continuity of care if you didn’t have information on what was done previously on the patient? Or what if the information you had was incorrect? Information blocking hinders interoperability, which hurts patients in the long run.
As a patient, it can be frustrating as well to not have easy access to your own health information. According to a Pew survey, “61% percent of adults said they would want to be able to download their records to applications on mobile devices to help them manage their own health.” In addition, the survey found that most adults (81%) would support enabling different health care providers to share patient health record information between their EHR systems when they are caring for the same patient.
What has been done to alleviate the problems that come from information blocking? There are a few regulations that have been put in place. The 21st Century Cures Act (Cures Act) was signed into law in 2016 to help accelerate medical product development and bring new innovations and advances to patients who need them faster and more efficiently. In 2020, the Office of the National Coordinator for Health Information Technology (ONC) issued a final interoperability rule for the Cures Act stating that health systems, EHR vendors, and health IT developers can be held accountable for blocking data. The rule includes eight exceptions that don’t count as information blocking. With these regulations, the Department of Health and Human Services (HHS) can issue a penalty of up to $1 million per information blocking violation to health IT developers. In addition to the U.S. government’s efforts, the American Medical Association (AMA) also supports the end of data blocking.
What can healthcare providers do to eliminate information blocking? Providers can start by evaluating current processes to make sure that they are compliant with the Cures Act. By doing so, healthcare organizations can start looking into the best solutions to share data and reduce their reliance on an EHR that may not meet all their data sharing needs. Healthcare organizations can also deploy a Fast Healthcare Interoperability Resources (FHIR) server to help with data sharing and extended EHR functionality.
How are you solving the issues of information blocking and making sure that your processes and systems are compliant with the Cures Act? If you’re looking for technology solutions that can help you aggregate and find the right information efficiently, please reach out to us. Our team can help your organization evaluate your processes and systems to come up with some solutions to promote interoperability.
Attending the ANIA Annual Conference this year? Stop by our Booth #207 to chat. More info on ANIA here.
Attending the HIMSS conference this year? Stop by our HIMSS kiosk and interoperability showcase booth: C200-11 and C200-131 and we would love to chat with you.