Competition among providers and separately among vendors is not leading to wholesale information blocking and the lack of electronic health record sharing, according to the Health IT Policy Committee’s interoperability task force. The committee, which advises federal officials, bases its conclusion on feedback gathered in two separate virtual hearings held earlier this month with stakeholders.
While many industry observers argue that the main challenges to HIT interoperability are not technical but business-related, the task force found that when it comes to financial barriers to interoperable EHRs a cut-throat competitive business environment is not among the major contributing factors.
“We did not hear—even though that was one of our topics—that competition or fear of competition was a big factor in why we didn’t have as much interoperability as we’d hoped,” said Paul Tang, chair of the task force, during Tuesday’s Policy Committee meeting that summarized and discussed themes from the hearings.
However, the task force’s observation flies in the face of an April 2015 report to Congress from the Office of the National Coordinator for Health IT which highlighted the problem of electronic health information blocking, drawing attention to how both provider and vendor “bad actors” are interfering with data exchange. In its report, ONC argued that some EHR vendors are preventing the exchange of health information with competitors and how some providers engage in information blocking to control referrals and enhance their market dominance over competitors.
According to the ONC report, 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.” The agency further contends that such “business practices, though they may arguably advance legitimate individual economic interests, interfere with the exchange of electronic health information in ways that raise serious information blocking concerns.”
Nonetheless, the HITPC interoperability task force walked away from its stakeholder hearings with a different impression of market conditions and the impact of competition on providers and vendors.
“To the extent that there are active [information] blockers perhaps with malice, it doesn’t feel like we heard a lot of that,” said Micky Tripathi, president/CEO of the Massachusetts eHealth Collaborative and a member of the interoperability task force. “We didn’t hear a lot of it on the provider side with providers actively blocking information flows for competitive purposes, as well as on the vendor side and the issue of vendors behaving in anti-competitive ways against each other. It just didn’t come out for whatever reason.”
Still, Tripathi added: “Now that doesn’t mean that it never exists anywhere. But, I don’t recall it coming out as being a really large theme.”
The HITPC task force is currently examining the clinical, technical, organizational and financial barriers to health IT interoperability. The task force will provide initial recommendations to the full Policy Committee in September, then issue final recommendations in October that will ultimately be reported to Congress.
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