- Are healthcare providers and EHR vendors actively trying to block health data interoperability and health information exchange? Maybe so, but hard evidence is difficult to come by, says a report from the Office of the National Coordinator.
The brief, commissioned by Congress in an effort to speed up the belabored process of ensuring that healthcare providers can access patient data when and where it’s needed, outlines a number of strategic steps that the ONC hopes will prevent data blocking as the industry increasing relies on clinical analytics and health information exchange for timely, accurate patient care.
After spending billions of taxpayer dollars on the EHR Incentive Programs with questionable results for health information exchange, Congress requested an ONC report on the state of health data interoperability in the 2015 omnibus budget. In the same breath, lawmakers threatened to require the agency to decertify EHR technology that prevents providers from sharing information across the care continuum. “ONC is urged to use its certification program judiciously in order to ensure certified electronic health record technology provides value to eligible hospitals, eligible providers and taxpayers,” the appropriations bill said.
“ONC should use its authority to certify only those products that clearly meet current meaningful use program standards and that do not block health information exchange,” Congress continued. “ONC should take steps to decertify products that proactively block the sharing of information because those practices frustrate congressional intent, devalue taxpayer investments in CEHRT, and make CEHRT less valuable and more burdensome for eligible hospitals and eligible providers to use.”
But it’s hard to prove that providers concerned about market share and patient revenue are purposely making it difficult to share data, or that vendor fees for health information exchange aren’t just part of the cost of doing business.
Anecdotes and anonymous complaints about data hoarding abound, yet “the extent to which information blocking is impeding the effective sharing of electronic health information is less clear” than challenges to interoperability related to a lack of data standards or purely technical obstacles, the report states. “While ONC and others are studying the problem, formal research is limited and anecdotal evidence is often difficult to interpret and still more difficult to generalize.”
Even the definition of “information blocking” is up for debate, the ONC argues. “Many actions that prevent information from being exchanged may be inadvertent, resulting primarily from economic, technological, and practical challenges that have long prevented widespread and effective information sharing. Further, even conscious decisions that prevent information exchange may be motivated by and advance important interests, such as protecting patient safety, that further the potential to improve health and health care. These interests must be carefully balanced with the potential benefits from sharing of electronic health information.”
Patient privacy, safety, and security issues aside, it is fairly clear to most players in the industry that health data interoperability has hit some major roadblocks, not all of which are HIPAA related or technical in nature. The ONC identifies some of these obstacles, including unreasonable contract terms, exorbitant data exchange fees, selling health IT products that deliberately require add-ons, complex workarounds, or developing products that “lock in” providers to systems that impede the flow of information.
Thought the majority of complaints reviewed by the ONC were directed towards the developer community and its creative ways of extracting fees from its customers, vendors aren’t the only ones to blame. Not all healthcare providers have embraced the notion that sharing is caring, especially when it comes to jealously guarded revenue streams.
While the report recognizes that providers have a right to protect their consumer base and their investments in health IT infrastructure, the practice of withholding patient data in order to control referrals, keep patients in-network, and boost market dominance is crossing the line.
Large healthcare systems seem particularly at fault, the ONC says, especially for-profit health systems and hospitals that operate in tightly competitive markets. “Evidence shows that larger hospital systems are more likely to exchange electronic health information internally, but are less likely to exchange electronic health information externally with competing hospitals and unaffiliated providers. This in turn reduces the likelihood that these other providers will exchange information.”
The spread of value-based reimbursements hopes to reduce the financial motivations for keeping data stagnant, and the ONC has outlined its plans to tackle the industry’s unwillingness to relinquish its tight grip on information that arguably doesn’t even really belong to them. The first step may be to increase monitoring and surveillance of certified EHR technology (CEHRT) as it is used in real-life situations, and put meaningful consequences on the table, including decertification. Future CEHRT criteria should include more stringent requirements for the use of data standards and transparency, while ONC governance related to health data interoperability should be more explicit about what constitutes data blocking and inadequate health information exchange.
The ONC also plans to coordinate with the HHS Office for Civil Rights (OCR) to clarify HIPAA provisions that do and do not permit the sharing and disclosure of personal health information, as well as with the Office of the Inspector General to ensure that developers and providers are adhering to federal anti-kickback rules and physician self-referral laws. Providers and vendors who willingly violate these statues or other regulations will be referred to the appropriate law enforcement agency, the report adds.
As the ONC continues to gather empirical information about health data interoperability practices, and potentially enlist the help of Congress to supplement its oversight, it will also try to encourage innovation and heathy competition between health IT developers to promote data sharing and information exchange across standards-based systems.
“Information blocking is certainly not the only impediment to an interoperable learning health system. But the findings in this report suggest that it is a serious problem—and one that is not being effectively addressed,” the report concludes. By implementing a comprehensive strategy to reduce obstacles to meaningful sharing while allowing providers and developers to preserve their competitive edge, the ONC hopes to resolve the interoperability issues that have caused such consternation across the healthcare spectrum.