Technology vendors, hospitals, and health systems restrict data access under the guise of security and confidentiality, but it can be challenging to identify and differentiate information-blocking from more benign impediments, says an ONC report.
The federal government’s $28 billion investment in health information technology interoperability is undermined by vendors and providers who don’t want to share data with perceived competitors, a new study says.
In a report requested by Congress, the Office of the National Coordinator for Health Information Technology said that “information blocking” is a significant problem that is likely to get worse as expectations and the capabilities for HIT mature and improve.
Because of gray areas that include contract restrictions on the disclosure of relevant evidence, and unavoidable technology glitches and snafus, ONC said it can be challenging to identify and differentiate information blocking from more benign impediments.
“However, based on the evidence and knowledge available, it is apparent that some healthcare providers and health IT developers are knowingly interfering with the exchange or use of electronic health information in ways that limit its availability and use to improve health and health care,” ONC said.
“This conduct may be economically rational for some actors in light of current market realities, but it presents a serious obstacle to achieving the goals of the HITECH (Health Information Technology for Economic and Clinical Health) Act and of healthcare reform.”
Most complaints about information blocking target HIT developers, ONC said.
“Many of these complaints allege that developers charge fees that make it cost-prohibitive for most customers to send, receive, or export electronic health information stored in EHRs, or to establish interfaces that enable such information to be exchanged with other providers, persons, or entities,” the report says.
“Some EHR developers allegedly charge a substantial per-transaction fee each time a user sends, receives, or searches for (or “queries”) a patient’s electronic health information. EHR developers may also charge comparatively high prices to establish certain common types of interfaces—such as connections to local labs and hospitals. Many providers also complain about the costs of extracting data from their EHR systems for their own use or to move to a different EHR technology.”
Providers were not exempt from criticism, particularly hospitals and health systems that ONC said were blocking data access under the guise of security and confidentiality to control referrals and enhance market dominance.
“Such constraints are not information blocking insofar as they are consistent with the requirements and policies established by federal and state law that protect patients’ electronic health information,” ONC said. “But it has been reported to ONC that privacy and security laws are cited in circumstances in which they do not in fact impose restrictions.”
For example, ONC said providers cite HIPAA privacy rules when denying the exchange of electronic protected health information for treatment purposes, even though HIPPA specifically permits such disclosures.
ONC said it has also received complaints and anecdotes about some providers and vendors in cahoots to block information exchanges with unaffiliated providers.
“A developer may have the requisite trust relationships and technological capabilities to exchange secure messages using the federal Direct standard with a large network of providers,” ONC said.
“But the developer and provider may implement this capability so as to restrict the exchange of information to physicians who are members of the provider’s care network (e.g., by preventing users from entering a recipient’s Direct email address and requiring instead that users select recipients from a pre-populated drop-down list).”
Who Owns the Data?
Chris Van Gorder, president/CEO of San Diego-based Scripps Health, says the healthcare sector has mostly come to understand that health records belong to the patient.
“I’m sure a few providers are concerned about patients getting access and not understanding the information in the record, but I suspect there are people in the world that get access to their financial information from banks and don’t completely understand that data either. It is still readily available to them,” Van Gorder says.
The only legitimate concern providers have with patient data exchanges is confidentiality, Van Gorder says, because providers are liable for any release of confidential patient data to anyone other than the patient.
He says a bigger obstacle than information blocking is the lack of interoperability of the data.
“We have no standards and requirements for interoperability and that is a huge problem,” he says. “We are at the point now where we are connecting medical devices to electronic patient records, except that the makers of medical devices have not yet done what the makers of USB sticks have done.”
“Each of our thousands of medical devices that can move patient information straight to the patients’ electronic medical record has to be done through a unique connection. This results in a very expensive and complex system. Keep in mind that medical decisions are based on that information so we have to get it right.”
Van Gorder, who last week was named to the board of directors at the Center for Medical Interoperability, says the nation’s healthcare grid needs to develop “a plug-and-play system of medical interoperability that will feed timely and accurate patient information into the EHR. We can improve quality and lower costs at the same time. This effort will need to be adopted and supported by the major EHR vendors as well.”