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by Darcey Trescone

Interoperability has been a long discussion with multiple challenges and slow execution. One theme that is in the literature still is “information blocking” because “health information exchange (HIE) between health systems and across electronic health record (EHR) vendors’ platforms may not be perceived as strategically beneficial to these entities.”^1.

The data suggest that information blocking is common even today. Health systems fear lost market share to the competition because of seamless access to patient information. In comparison, EHR vendors charge high prices for connectivity to other applications and have concerns about intellectual property and competition.

The information blocking regulations at 45 CFR Part 171 began to apply to health care providers, health IT developers of certified health IT, health information exchanges, and health information networks on April 5, 2021, per ONC's recent interim final rule.^1. Current policymaking focuses on how to prevent blocking the electronic sharing of patient data necessary for clinical care.

Despite the challenges related to measuring information blocking, it is essential to understand that perceptions play a part in what it is and how it occurs. The ONC will be investigating reports of information blocking on a case-by-case basis because information blocking is more than whether electronic health information did not flow freely.

Journal of the American Medical Informatics Association
– Study published January 2021

Eighty-nine of 106 HIEs were surveyed about their experience with information blocking prevalence among EHR vendors and health systems. Based on HIE observations, information blocking practices were higher among EHR vendors than health systems. "Fifty-five percent of HIEs reported that EHR vendors sometimes or routinely engage in practices that they perceive to be information blocking compared to 30% of HIEs said that health systems sometimes, often, or routinely engage in those practices."¹

Setting prices that HIEs perceived to be unreasonable was the most common practice by EHR vendors. "Eighty-two percent of HIEs reported that they sometimes or often observed practices that might constitute information blocking in the form of high prices. Forty-two percent of HIEs reported that they believe vendors often use high prices to limit access, exchange, or use of electronic health information, while 40 percent said they sometimes do."¹

For health systems, the most prevalent practice reported was health systems refusing to share information. "Fifty-six percent of HIEs said they sometimes or often observe instances of refusal, 15 percent of HIEs indicated health systems often refuse, and 41 percent of HIEs indicated health systems sometimes do. Thirty-seven percent of HIEs also said health systems sometimes or often use artificial barriers to limit access, exchange, or use of electronic health information."¹ The prevalence and practices observed in this study and prior research point to the importance of information blocking regulations.

ONC Cures Act Final Rule

ONC's Cures Act Final Rule supports seamless and secure access, exchange, and use of electronic health information. The concept of this rule is to give patients and their healthcare providers secure access to health information. The overall goal is to increase innovation and competition by fostering an ecosystem of new applications to provide patients with more choices in their healthcare.²

It calls on the healthcare industry to adopt standardized application programming interfaces (APIs), which will help allow individuals to access structured electronic health information using smartphone applications securely and efficiently.²

The rule outlines eight exceptions to the definition of information blocking.

Exceptions to Information Blocking

The ONC published the Cures Act Final Rule to establish such exceptions, their boundaries ("conditions"), and when each could apply. Moreover, it is vital to keep in mind that following or "using" an exception is not mandatory – it is the vendor or health system's choice. If there are allegations that information blocking occurred and a vendor or health system did not follow or cannot use a relevant exception, that could put their organization at significantly more risk.² The Cures Act Final Rule established eight exceptions that fall into two categories:

Category 1: Exceptions that involve not fulfilling requests to access, exchange, or use EHI

• Preventing Harm Exception
• Privacy Exception
• Security Exception
• Infeasibility Exception
• Health IT Performance Exception

Category 2: Exceptions that involve procedures for fulfilling requests to access, exchange, or use EHI

• Content and Manner Exception
• Fees Exception
• Licensing Exception

The Millbank Quarterly
– Study Published in 2017

Of the 60 respondents, 59 worked with both EHR vendors and providers, and the remaining respondent worked with only EHR vendors.  On average, respondents had worked with 18 EHR vendors and 31 hospitals or health systems.³

Frequency of Information Blocking

Fifty percent of respondents reported that EHR vendors routinely engage in information blocking, with an additional 33 percent reporting that EHR vendors engage in information blocking "occasionally." The frequency of information blocking by hospitals and health systems was lower. Twenty-five percent of respondents indicated that these providers routinely engage in information blocking, with an additional 34 percent reporting that they do so occasionally and 41 percent saying that information blocking was rare.³

Forms of Information Blocking

Among the eight specific forms of information blocking in which EHR vendors may engage, 49 percent of respondents reported that vendors routinely or often deploy products with limited interoperability. Forty-seven percent of respondents said that vendors routinely or often charge high fees for HIE unrelated to cost, followed by 42 percent that reported that vendors routinely or often make third-party access to standardized data "difficult.^"3

Among the three specific forms of information blocking in which hospitals and health systems may engage, 28 percent of respondents reported that they routinely or often coerce providers to adopt EHR or HIE technology, followed by 22 percent that said that hospitals/health systems routinely or often control patient flow by selectively sharing patient information.³

In Conclusion

Both studies suggest that policymaker concerns about information blocking are founded and that efforts to pursue policy actions to curb information blocking are warranted. Due to the limitations of the studies and the April 2021 change in the final rule, additional research should be conducted. The ONC is planning further studies regarding information blocking and is hopeful to see a decrease in reported practices that may constitute information blocking.

 

¹ Everson J, Patel V, Adler-Milstein J. Information blocking remains prevalent at the start of 21st Century Cures Act: results from a survey of health information exchange organizations. Journal of the American Medical Informatics Association. 2021;28(4):727-732. doi:10.1093/jamia/ocaa323

² Healthit.gov. https://www.healthit.gov/sites/default/files/cures/2020-03/InformationBlockingExceptions.pdf. Published 2021. Accessed May 23, 2021.

³ Adler-Milstein J, Pfeifer E. Information Blocking: Is It Occurring and What Policy Strategies Can Address It?. Milbank Q. 2017;95(1):117-135. doi:10.1111/1468-0009.12247.

 

 

Darcey Trescone is a Healthcare IS and Business Development Consultant in the Post-Acute Healthcare Market with a strong background working with both providers and vendors specific to Home Care and Hospice. She has worked as a home health nurse and held senior operational, product management and business development positions with various post-acute software firms, where her responsibilities included new and existing market penetration, customer retention and oversight of teams across the U.S., Canada and Australia. She can be reached at darcey@tresconeconsulting.com.

©2021 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com