Solving the issue of information blocking is one of the key tenets of federal initiatives to promote interoperability, but some industry leaders question how significant of an impediment the practice is in healthcare today.

The Office of the National Coordinator for Health IT has told Congress that some providers and vendors are preventing the sharing of electronic health information in ways that not only serve to frustrate the goals of the HITECH Act but undermine the broader objectives of ongoing healthcare reforms.

The agency has suggested that information blocking—which it defines as knowingly and unreasonably interfering with health information sharing—is occurring in healthcare and may become more prevalent as technical and other interoperability challenges are reduced, leading to “greater information sharing and data liquidity.”

“We encounter information blocking sometimes due to misundertandings of rules like HIPAA, or other times through business practices that put up barriers to data, such as paywalls where information is stopped from flowing seamlessly to support patient care,” National Coordinator for HIT Karen DeSalvo, MD, told reporters earlier this month at the HIMSS16 conference in Las Vegas.

John Halamka, MD, (left) talks to Henry Feldman, MD, at Beth Israel Deaconess Medical Center
John Halamka, MD, (left) talks to Henry Feldman, MD, at Beth Israel Deaconess Medical Center

As part of the federal government’s strategy to address the problem, the Department of Health and Human Services announced at HIMSS16 that major providers and vendors have pledged to not block electronic health information—one of three commitments they made to improve interoperability.

“A year ago, when we released the blocking report [to Congress], there were a host of organizations who denied that blocking was even happening,” DeSalvo said. “So, to move culturally to a place where these groups are willing to publicly say that they want to engage in something that they now acknowledge actually can exist in the marketplace is a big cultural shift.”

However, some of the industry’s most prominent interoperability experts question whether information blocking practices are occurring.

“When there is a competent vendor and a business need to exchange data, I have never seen the volitional blocking of health information exchange,” observes John Halamka, MD, CIO of Beth Israel Deaconess Medical Center. “There may be haggling over the price of interfaces or the time to implement, but no willing disruption of commerce.”

At the same time, Halamka acknowledges that he has also witnessed “incompetent vendors who cannot reliably implement standards” and “requests for information sharing without a business case.” Nonetheless, as CIO of a large Boston-area provider, Halamka asserts that he has “never seen competent vendors and providers with a business case for data exchange ‘knowingly and unreasonably interfering with information sharing.’ ”

Likewise, Micky Tripathi, CEO of the Massachusetts eHealth Collaborative, argues that information blocking is not a major standing in the way of health information exchange. “It wouldn’t even be in my top 10 list,” Tripathi says. “There are certainly bad actors, as there are in any industry. I have seen it only once in the 14 years that I have been in the healthcare industry, and in that case it was the provider, not the vendor, who was the guilty party.”

Similarly, Charles Jaffe, MD, CEO of Health Level Seven (HL7) International, doesn't believe that EHR vendors are “volitionally” blocking information or that it’s a business model or practice.

“I do believe policies and regulation create hurdles that lead to failure in interoperability,” Jaffe contends. “Furthermore, I believe that some healthcare systems are reluctant to share information. Moreover, I suspect that poor business models for health information exchanges contribute to a lack of incentives. Finally, the lack of sufficiently constrained standards and absence of adequate mappings between vocabularies and taxonomies exacerbate the problem.”

Tripathi concludes that health information exchange “will flourish if we keep our focus on expanding opportunities to derive business value from better clinical outcomes, rather than creating elaborate regulatory and investigatory structures to search for a needle in a haystack.”

For his part, Jaffe points to HL7’s emerging Fast Healthcare Interoperability Resources (FHIR) standard as a way for providers and vendors to implement common application programming interfaces (APIs).

“In general, I believe that policy trumps technology. For example, we would have less difficulty sharing healthcare data if we were to implement a uniform patient identifier,” adds Jaffe. “When FHIR is widely implemented, and when healthcare systems and vendors open their APIs, we will see an incremental advance in interoperability.”

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