With much fanfare, the Office of the National Coordinator for Health Information Technology in April sent a report to Congress on the problem of electronic health information blocking.
Now, the HIMSS Electronic Health Record Association is asking ONC to clarify its definition of information blocking.
“We believe that information blocking definitely needs to be addressed where it occurs if it’s intentional and unreasonable, based on the current ONC definition,” says Sarah Corley, M.D., EHRA vice chair and chief medical officer for NextGen Healthcare. “Where we need clarity is more examples of what is information blocking, because the devil is in the details.”
“Given the recent focus on information blocking and the fact that providers are actively implementing policies to avoid actions that could be construed as data blocking, EHR developers and their clients are anxious to receive guidance on this issue,” adds Leigh Burchell, EHRA chair and vice president of government affairs at Allscripts.
The trade association of EHR vendors recently sent a letter to National HIT Coordinator Karen DeSalvo, M.D., pointing out that “there are a limited number of anecdotes of information blocking, but determining which are truly information blocking per the definition is not easy.”
Specifically, EHRA stated that “any assessment of potential information blocking must be fact-based, given a specific situation, and include the perspectives of all stakeholders before declaring that information blocking has, in fact, occurred.”
But, according to EHRA, the problem with information blocking is more perception than reality. While there is the “perception that information blocking exists,” the organization states in its letter to DeSalvo that “in many cases, there is no intent to interfere, but rather a series of events that result in less data exchange than desired by some parties.” As a result, EHRA concludes: “We run the risk of overreaction to what appear to be isolated incidents.”
Nonetheless, ONC’s report to Congress concluded that some providers and vendors have created technical, legal and business barriers between their EHR systems and other systems to interfere with access to information. However, Corley at NextGen challenges the assertion that provider and vendor “bad actors” are interfering with data exchange to the detriment of patients and their care.
“I don’t think that we have good data on exactly on much deliberate, intentional, and unreasonable information blocking is going on right now,” she comments. “You can certainly see business drivers that affect decisions on information sharing. And, this is one of the areas that we want to see clarification.”
Earlier this month, the Department of Health and Human Service’s Office of the Inspector General issued an alert to the healthcare industry warning that information blocking may affect EHR safe harbor protections under the federal anti-kickback statute.
“Enforcing the Stark anti-kickback exemptions in this area could be one route to providing motivation for change where any problematic activities are evident, but we believe the industry needs more clarification on exactly what information blocking is before these mechanisms are enforced,” says Burchell.
With regard to the federal Anti-Kickback Statute, EHRA in its letter to ONC states that “it would be helpful to understand who is permitted to make investments in interoperability (licenses, fees, infrastructure, management, etc.) on behalf of other parties, thus potentially removing obstacles to exchanging data more widely.”
Corley concludes that EHRA “definitely believes that if people are unreasonably and deliberately blocking information, then there needs to be penalties assessed” but not without better definitions from ONC. “If they’re going to start enforcing it, you want to make sure that they’re adhering to some well-defined definitions of what it is exactly.”
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