National Coordinator for Health IT Karen DeSalvo, M.D., told reporters at HIMSS15 this week that interoperability remains ONC’s top priority and that the development of its draft nationwide Interoperability Roadmap “has been an all-hands-on-deck” effort in partnership with the private sector.

When it comes to identifying and addressing the main business and technical barriers to interoperability, ONC shined a light late last week on the problem of electronic health information blocking in a report to Congress, drawing attention to how both provider and vendor “bad actors” are interfering with data exchange.

Also See: Data Blocking Hampers Interoperability, ONC Says

Jodi Daniel, director of ONC’s Office of Policy, said the report was generated in response to a congressional request but that information blocking is “something that we’ve been hearing about a lot more over the past year.” According to Daniel, ONC believes that although information blocking is just one of several health IT interoperability challenges it is a “problem that we need to address” and “need to take action on.”

However, she noted that while other agencies might have jurisdiction in the area of information blocking—such as the Federal Trade Commission with regard to anti-competitive practices—ONC “doesn’t have the authority to go out and do investigations and enforcement of practices” and that it is an area “where there are some gaps in what the federal government as a whole can do.”

DeSalvo added that solving the problem of electronic health information blocking is going to take a concerted effort of federal agencies as well as the private sector “including providers and developers to set expectations and to set contracts and be willing to have more transparency.” She also said that if necessary “there may be additional opportunities for Congress to weigh in.”

Daniel told Health Data Management that Congress has suggested decertification of health IT products as a “mechanism” for dealing with bad actors whose technical capabilities (i.e., proprietary standards rather than common standards) are blocking information exchange. But, she warned that decertifying such products is a “blunt instrument” that could have negative effects on providers.

“If we decertify a product that a lot of providers are using, then the providers don’t have a certified product and either they have to switch products or they will fall out of compliance with Meaningful Use,” said Daniel. “It might penalize the bad action by a vendor, but it will cause harm to innocent providers.” 

ONC Chief Privacy Officer Lucia Savage commented that “people think about information blocking sometimes as a technology concern, but if you read the report you’ll find out that we’ve identified ways in which information is blocked both by business practices and technology.” Some of those business practices are a result of “misunderstandings” by persons or organizations around privacy and security that must be “alleviated” to ensure that “information can flow as it’s intended to under HIPAA,” Savage said.

According to ONC, some providers have been known to cite the HIPAA privacy rule as a reason for denying the exchange of electronic protected health information for treatment purposes. Among the targeted actions recommended in ONC’s report to Congress is for the agency to work with the Department of Health and Human Services’ Office for Civil Rights to improve stakeholder understanding of the HIPAA rules related to information sharing.

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