Delegates Call AMA to Advocate for Provider Info-Blocking Flexibility

Delegates at the June 2021 Special Meeting of the AMA Delegates called for changes to the ONC information-blocking regulations that would allow providers the discretion to withhold patient data sharing if the knowledge would negatively affect a patient emotionally or mentally. 

Federal information-blocking regulations outlined in the 21st Century Cures Act require providers to share patient data unless they believe the information would lead a patient to hurt herself physically.

However, this exception does not consider the emotional or psychological harm certain health data may bring patients, according to a resolution presented at the meeting.

“The current regulation that permits a physician to withhold the release of information in cases of anticipated physical harm is a blinkered view of the patient-physician relationship,” AMA Board Chair-elect Bobby Mukkamala, MD, said at the meeting. “It denies physicians their ability to exercise their expertise and training to evaluate the needs of a patient.”

Mukkamala noted that the information blocking regulations’ blind spot may affect adolescent patients most. The current regulations require physicians to share information regarding substance use, reproductive health, and mental health to parents or patients’ proxies.

Mukkamala explained that sharing this sensitive information with patients’ family members or guardians could lead to emotional distress for the patient as they may be left to deal with negative reactions from their loved ones.

“Adolescents trust their physicians to guide them through difficult times,” Mukkamala said.  “This change would build stronger trust.”

The delegates called for AMA to advocate for the Office of Civil Rights (OCR) to revise the harm exception definition to include mental and emotional distress.

Delegates also urged the AMA to advocate for the OCR to assemble a commission of medical professionals for review of the definition of harm. Additionally, the commission could provide evidence that mental, emotional, and physical health are intertwined, the representatives said.

Next, the delegates called for ONC and its Office of Inspector General to leverage their enforcement discretion to afford practices additional compliance flexibilities.

Lastly, the delegates urged the ONC to consult with relevant stakeholders about unintended consequences that could come from the information-blocking regulations.

Representatives also called attention to another health IT issue; some EHRs and ePrescribing programs may advertise to physicians at the point of care.

The good news is that pharmaceutical marketing within EHR systems is uncommon, and there is no indication that this kind of advertisement is becoming more popular, according to an AMA Board of Trustees report adopted at the meeting.

According to the report, the top five EHR systems—which make up 85 percent of the market share—do not appear to have advertisements within their technology. However, a small portion of the other 15 percent may generate revenue through ads.

Pharmaceutical advertisements withing the EHR may falsely influence providers’ care management by distracting them from the patients’ needs health record in front of them.

While only a few vendors offer partnerships with pharmaceutical companies, the fact that some pharmaceutical advertisements could end up in EHRs is a problem, the report concluded.