Information blocking—both by providers and vendors—is preventing the sharing of patients’ electronic health records and dashing any hope of realizing true EHR interoperability, according to witnesses who testified during a Senate health committee hearing on Thursday.

“When patients and providers have more convenient access to better health information, they are more equipped to make truly life-changing or even life-saving decisions,” Ranking Member Sen. Patty Murray (D-Wash.) told the committee. However, Murray warned that the “practice of deliberate information blocking by some health IT organizations threatens to get in the way of progress we need to make to continue to improve our healthcare system.”

In his testimony, David Kendrick, M.D., chair of the Department of Medical Informatics at the University of Oklahoma and CEO of MyHealth Access Network in Tulsa, defined information blocking as the intentional interruption or prevention of interoperability by one of two parties: the provider or the provider’s EHR vendor.

“While many EHR vendors work well with their customers and with our organization to establish interoperability, we still have so many specific experiences with inappropriate data blocking and sub-standard data quality that we’ve created a nomenclature to classify six common types,” testified Kendrick. “By far the most common barrier to interoperability is the high price charged by vendors to implement and maintain interfaces, which commonly exceeds $10,000 and is not uncommon to see charges of $30,000 to $40,000 per practice—regardless of practice size—to do something that Meaningful Use supposedly had required.”   

Also See: Info Blocking Gains Prominence as Interoperability Challenge

In April, the Office of the National Coordinator for Health IT sent a report to Congress on the problem of electronic health information blocking, discussing how provider and vendor “bad actors” are interfering with data exchange to the detriment of patients and their care. According to the ONC report, some providers and vendors have created technical, legal and business barriers between their EHR systems and other systems to interfere with access to information. 

“Information blocking could loosely be defined as something or someone intentionally interfering with access to my personal electronic health information,” said Sen. Lamar Alexander (R-Tenn.), chairman of the committee. “It might be physicians and hospitals blocking patient information from being shared with competing physicians and hospitals to keep patients. Or it might be electronic health records vendors blocking information so they can increase their market share.”

Pointing Fingers

Testifying on behalf of the American College of Cardiology, Michael Mirro, M.D., chief academic research officer for the Parkview Mirro Center for Research and Innovation in Fort Wayne, Ind., told the committee that he first became aware of information blocking when his colleagues in other private cardiology practices adopted EHRs and were forced to spend substantial resources to interface with their health system’s EHR.

“These practices would have been able to better plan financially if these costs had been disclosed during the contracting,” Mirro testified. Transparency of additional or hidden fees within contracts with EHR vendors should be evaluated.”

In addition, he said that many contracts between providers and EHR vendors include gag clauses which prevent providers from speaking publicly about technical problems associated with their EHRs or unfair pricing. “EHR vendors should not be allowed to include such clauses in the contracts,” according to Mirro, who also recommended that EHR systems from different vendors should be able to interconnect.

“Many EHR vendors provide the functionality needed, but require the user to purchase their health IT products to make the elements of the EHR interoperable,” added Mirro. “Like other products such as consumer electronics, you are able to connect, but you must buy a specific company’s products to do so with ease. The ramifications of technology in healthcare that are unable to communicate are serious, resulting in decreased care quality and stunting improvements in population health.”

Yet, Paul Black, president and CEO of EHR vendor Allscripts, blamed information blocking on the “lack of a strong business case or a true market driver for interoperability” among providers.

“At the end of the day, healthcare in most environments is a business where margins must be considered and the bills paid, and the current payment system simply does not provide appropriate financial motivation for providers to truly be invested in creating an interoperable healthcare environment; this is especially true given that the burden of cost falls to them almost exclusively,” said Black. “Healthcare providers are genuinely committed to providing the best care they can to patients, of course, but in many instances, the common reality of running on only a few days’ cash flow often trumps loftier goals.”

According to Black, government is the solution to the problem. “Much as CMS policy has already had a marked impact on hospital readmission rates by associating them with payments, creating a direct relationship between payment and data exchange would have the same result,” he argued. “This could be the strongest step taken to create a genuine imperative for interoperability.”    

Similarly, David Kibbe, M.D., president and CEO of DirectTrust, a consortium which supports secure, interoperable health information exchange via the Direct message protocols, said he strongly believes there is a role for government to encourage and incentivize interoperable health information exchange. Ultimately, however, Kibbe asserted that the responsibility for assuring the secure interoperable exchange of health information resides with providers, not EHR vendors or government.

At the same time, when it comes to offending EHR vendors, Kibbe was not shy about pointing fingers. “It’s no secret in the industry that there are two leading companies in particular—Epic and eClinicalWorks—which both have over the course of the years developed their own proprietary messaging systems,” he said. “I think that one of the reasons why they have perhaps found it difficult to adopt Direct for their customers is because of their business model.”

Kibbe commented: “It’s important for them not to create the problems in the marketplace that Dr. Kendrick mentioned.” In the same vein, Kendrick added: “I find it’s ironic that large vendors who claim huge amounts of interoperability are primarily exchanging data with themselves—with other installations of their own product.”      

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