ONC fail: EHR 'data blocking' still rampant

Manuel Prado, president of Viva Transcription, Santa Cruz, Calif., publicly complained two years ago about the high interface fees – up to $10,000 – that electronic health record vendors charged for each hospital or physician practice they connect to his transcription service. “That's data blocking,” he charged. “If taxpayers are contributing $44,000 or $63,000 (in federal Medicare and Medicaid incentive payments) for each EHR, it's not too much to ask” that they make interconnect charges free.

More than five years after Congress in the American Recovery and Reinvestment Act mandated HHS' Office of the National Coordinator for Health IT establish a “governance mechanism” for a seamless health information exchange system, the agency earlier this month confirmed that widespread “data blocking” still existed, largely due to actions by both software vendors and providers. In a report demanded by Congress, it also said that it still hasn't come up with an effective scheme for guaranteeing the free flow of electronic health records.

Growing frustration with the slow pace of making EHRs interoperable, including on Capitol Hill, has left federal officials scrambling to show they are doing something about the problem. “We would like to hear about every example – small, medium, large – when someone is getting in the way of interoperability,” Andy Slavitt, acting administrator of the CMS, said at the Health Information and Management Systems Society conference. “We want as a team to hear about these examples and confront them.”

They won't have to look far.

Dr. Matt Patterson, president of Airstrip, a LaJolla, Calif., developer of a medical device and IT integration platform, has been on the front lines in the national struggle for health information exchange. Extracting patient information from dozens of different devices and EHRs, each with their own way of exporting data, has been an effort, he said.

The company is routinely blocked from accessing the lines of code that enable one computer system to communicate with another, the so-called application programming interfaces. “The APIs are there, but are being blocked by vendors,” Patterson charged.

Even when they do get access, the lack of interoperability standards makes the task unnecessarily labor intensive. “We've had to go into every single proprietary system and trick out that mess,” then render the data presentable on Android, BlackBerry, Apple iOS and Windows powered mobile devices. “When I have to pay an interface fee to each vendor, that's a nice problem to have because in many cases, it's worse than that,” he said.

Some of the more egregious data-blocking practices like charging exorbitant fees are beginning to crumble. Last week, Epic CEO Judith Faulkner announced plans to eliminate health information exchange fees that ranged as high as 20 cents per record and an annual $2.35-per-person charge for receiving messages from non-Epic systems.

It joined Athenahealth, which also announced at HIMSS that it would absorb all information exchange costs made through CommonWell Health Alliance, an interoperability platform it and four other major EHR vendors launched last year. Cerner, McKesson and Evident, former CPSI, have made similar commitments.

But it is unlikely those moves will forestall growing scrutiny from Capitol Hill, where physician-Congressmen like Phil Gingery (R-Ga.) and Bill Cassidy (R-La.) have blasted industry leader Epic, based in Madison, Wis., for failing to make the extensive installations using its software easily available to providers who use other vendors.

ONC head Dr. Karen DeSalvo said she would remain on the lookout for perpetrators of data-blocking practices described in the agency's 39-page report. But her agency under a succession of leaders has consistently refused to use its regulatory powers to break the EHR interoperability logjam. In September 2012, the government dropped plans to set standards when the vendor industry complained it would stifle innovation. In January this year, the ONC released a 10-year national “interoperability roadmap.”

The ONC report said it would ask the Federal Trade Commission and other government antitrust authorities to look into alleged data blocking incidents. The FTC has investigated other industries where governance organizations colluded with established industry leaders to thwart competition. But the agency hasn't brought a single case against health IT vendors.

The government needs to intervene, said Airstrip president Patterson, by requiring the use of a basic set of standards for data exchange that meets providers' needs. The biggest challenge to interoperability is “not having the providers drive the standards development,” he said.