ONC report points finger at vendors, providers for information-blocking

A new report (PDF) to Congress from the Office of the National Coordinator for Health Information Technology (ONC) details several examples of electronic health records (EHR) developers and health systems blocking the sharing of health information between one other.

The act of information-blocking occurs when an entity or person knowingly and unreasonably interferes with the exchange of electronic health information. Examples of this practice:

• Charging prices and fees for data exchange;
• Creating terms of a contract that restrict individuals’ access to their health information;
• Developing health information technology (IT) in a non-standard way that dissuades information sharing; and
• Developing health IT in a way that locks in information.

Anecdotal evidence suggests that EHR application developers are breaking several of the rules in this regard, the report notes. Using interviews with people at regional extension centers, the authors detail complaints from industry sources about developers charging fees that make it cost-prohibitive to send, receive or export electronic health information stored in EHRs. Some EHR developers even charge a substantial transaction fee any time a user sends, receives or queries a patient’s electronic health information, the report says. The variation in prices reported to the ONC suggests that some are taking advantage of the situation.

Moreover, complaints over information-blocking usually arise because of contractual terms, technology design decisions and other business practices. Many EHR developers, according to the report, purposely prohibit customers from selecting an ONC-certified health information service provider (HISP) of their choosing and use only the developer’s HISP. This practice is problematic because it prevents end-users from meeting technical requirements necessary to exchange data with other providers, the report says.

The report does not acquit providers from information-blocking. It says that a common charge is that hospitals and health systems engage in information blocking to maintain their market dominance.

Evidence of information-blocking is difficult to analyze, notes Karen DeSalvo, MD, national coordinator for Health IT, writing in a blog announcing the availability of the report. “The full extent of the information blocking problem is difficult to assess, primarily because health IT developers impose contractual restrictions that prohibit customers from reporting or even discussing costs, restrictions, and other relevant details,” she writes. “Still, from the evidence available, it is readily apparent that some providers and developers are engaging in information blocking. And for reasons discussed in our report, this behavior may become more prevalent as technology and the need to exchange electronic health information continue to evolve and mature.”

To overcome information-blocking, the report suggests:

• Transparency obligations for health IT developers that require disclosure of restrictions and costs associated with interoperability;
• Certification requirements monitor health IT capabilities of applications;
• A governance framework for health information exchange that establishes principles on business, technical and organizational practices related to interoperability and information sharing; and
• Much more.

Preventing information will require congressional intervention, according to the authors of the report and the ONC. The report does not specifically offer any suggestions, however.

Congress requested a report on information-blocking in healthcare and a strategy to address it.

Gabriel Perna is senior editor of Long-Term Living sister media brand Healthcare Informatics.