The Office of the National Coordinator for Health Information Technology has sent a report to Congress detailing how electronic health information blocking is interfering with the exchange and use of information to improve outcomes, as well as strategies to address the problem.

“Since the enactment of the HITECH Act and subsequent legislation, the federal government has invested over $28 billion to accelerate the development and adoption of health information technology to enable an interoperable learning health system,” states the report. “While many stakeholders are committed to achieving this vision, current economic and market conditions create business incentives for some persons and entities to exercise control over electronic health information in ways that unreasonably limit its availability and use.”

Also See: EHR Business Environment Must Change to Achieve Interoperability

According to ONC, complaints and other evidence described in the 39-page report “suggest that some persons and entities are interfering with the exchange or use of electronic health information in ways that frustrate the goals of the HITECH Act and undermine broader healthcare reforms.” ONC’s report provides criteria for identifying and distinguishing electronic health information blocking from other barriers to interoperability, and details current and proposed actions.

“Information blocking is contributing to a lack of interoperability,” said National Coordinator for Health IT Karen DeSalvo, M.D., this morning in a briefing for members of the press. According to DeSalvo, ONC’s report defines electronic health information blocking, stating that it “occurs when persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information.”

Though ONC does not have “a lot of quantified information right now” as reflected in the report, she added that anecdotal reports from providers and vendors about instances of electronic health information blocking have been received by her staff helping to “advance our understanding about how prevalent the challenge is” for the healthcare industry.     

While ONC “needs better evidence to really understand and accurately measure the scope of information blocking,” the agency’s report to Congress provided “the perfect timing and opportunity for us to put something out that summarized the information that we had,” according to Jodi Daniel, director of ONC’s Office of Policy. Specifically, Daniel said that some of the business practices that are especially problematic in terms of limiting the electronic flow of information for clinical purposes are contractual restrictions that may limit the sharing of information, opportunistic pricing or unreasonable pricing structures that make it cost-prohibitive for providers to share information, and technical choices that may raise the cost or burden of health information exchange, including non-standard ways of exchanging information.       

In the report, ONC says that it “believes that information blocking is best addressed through a combination of targeted actions aimed at deterring and remedying information blocking, and broader strategies and approaches that engage the larger context in which information blocking occurs.” The report lays out actions that the agency is currently taking or has proposed to take, coordinating with other federal agencies, to target and address information blocking.

“While important, these actions alone will not provide a complete solution to the information blocking problem,” states the report. “Indeed, a key finding of this report is that many types of information blocking are beyond the reach of current federal law and programs to address. Thus a comprehensive approach will require overcoming significant gaps in current knowledge, programs, and authorities that limit the ability of ONC and other federal agencies to effectively target, deter, and remedy this conduct, even though it frustrates the important public policy of enabling electronic health information to flow in support of patients and improvements in health and healthcare.”

As a result, ONC’s report concludes that successful strategies to prevent information blocking will in fact require congressional intervention. “ONC believes there are several avenues open to Congress to address information blocking, including the gaps identified in this report, to ensure continued progress towards the nation’s health IT and health care goals,” according to the report. “We are continuing to analyze those gaps and look forward to working with Congress to identify the best solutions.”

The Report to Congress on Health Information Blocking is available here.

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