Federal health IT officials are calling out providers and technology vendors for business practices that block the electronic transfer of patient information.
HHS' Office of the National Coordinator for Health IT issued a report to Congress (PDF) saying that a variety of practices it dubs “information blocking” are common. But the ONC also says it can't quantify the extent of the problem and is limited in its ability to respond to it.
The agency said it received about 60 unsolicited reports of information blocking in 2014. The practices include excessive costs for information-sharing; a lack of contract transparency for technology buyers, who may not appreciate the costs of sharing information; efforts by vendors to make it difficult to download information from EHRs and port their systems to competitors' systems; and collusion between providers and vendors to prevent information from following to other software systems or healthcare providers.
But, acknowledged ONC head Dr. Karen DeSalvo, we "don't have a lot of quantified information right now.”
The agency is suggesting that the government conduct surveys or create a public reporting process for complaints that would generate better information about the problem.
The ONC said increasing the level of transparency in contracts and ramping up in-the-field surveillance by the agency's certifying bodies could help expose and correct the the practices.
According to the ONC's report, the variability of pricing for data-sharing suggests that the disparities are “opportunistic.”
“To the degree there's information blocking, and that can be exposed, that's a good thing,” said Jitin Asnaani, the executive director of the CommonWell Health Alliance, a group of EHR vendors formed promote data-sharing in the healthcare system.
But Asnaani cautioned that variable prices for sharing are a necessary part of the system. “There's good reason why it's difficult today to provide the same interface at the same way in different places,” he said. “You can't hire enough engineers to do it all. That's why you have to use pricing to throttle how quickly you can build interfaces.”
CommonWell includes several of the top EHR vendors in the country—excepting Epic Systems Corp.—and the idea is to simplify the process of data-sharing. Whereas the vendors and providers now typically build an interface between each spoke in the network, which is inefficient, CommonWell is attempting to centralize data-sharing.
The ONC's certification program for EHRs is supposed to give healthcare providers assurance that the software they buy will allow them to meet the government's criteria for meaningfully using the technology under the federal EHR incentive program. But providers still complain that products don't perform as advertised.
An increased number of in-the-field inspections, which would test the software as it works in the field, might expose software that is not performing as advertised and therefore allow for a greater level of sharing.
But because providers need certified technology to meet the federal requirements, the ONC would be reluctant to threaten decertification as a consequence of practices identified as information-blocking.
“ONC's ability to address this problem is limited in several respects,” the agency acknowledges in the report. That observation is echoed by industry observers.
“Much of the data-blocking is a product of business decisions made by stakeholders that is beyond effective control by the government,” said Robert Tennant, the director of health IT policy at the Medical Group Management Association.
The healthcare system, Asnaani said, is “rife with misaligned incentives” that stifle good behavior. Asnaani believes a private effort like CommonWell might address the problem without the ONC's intervention.
Dan Haley, vice president of government and regulatory affairs for CommonWell member Athenahealth, said he's glad the ONC is shining a light on the difficulties of sharing data—and he wants the agency to take a hands-off approach.
“The market is solving for this problem,” Haley said. “It's not because federal government is telling us we have to, it's because our clients are telling us we have to.”
