- Despite widespread disapproval and Congressional scrutiny, information blocking remains a problem for health information exchanges working to connect providers and their EHR systems.
Drawing data from a national survey of 60 HIE leaders, a new study by researchers at University of Michigan Schools of Information and Public Health found information blocking to be widespread and the policies in place to mitigate the practice ineffective.
The pair of researchers — Julia Adler-Milstein, PhD, and Eric Pfeifer — gathered data regarding information blocking, its varying forms, and the effectiveness of policies designed to reduce it.
Fifty percent of respondents reported engaging with EHR vendors who participated in information blocking, and a quarter of respondents reported hospitals and health systems are guilty of the practice.
“Among hospitals and health systems, the most common form was coercing providers to adopt particular EHR or HIE technology,” wrote Adler-Milstein & Pfeifer.
Based on their findings, researchers acknowledge more information is needed regarding precisely when and where information blocking occurs to make a more targeted impact in decreasing instances of the offense.
“These dynamics likely explain why the popular policy responses among our respondents included a mix of strategies that foster an environment with incentives that discourage information blocking and direct enforcement by making information blocking illegal,” they added.
Researchers also surveyed respondents regarding potential motives for EHR vendors and hospitals to engage in information blocking. Essentially, information blocking stems from a desire to stay ahead of other competing EHR vendors and health systems.
For-profit EHR vendors have a natural vested interest in increasing revenue by limiting the flow of data.
“The specific forms of and perceived motivations for information blocking were harder to predict a priori,” Adler-Milstein & Pfeifer explain. “What we found in relation to specific forms is that EHR vendors appear to most often engage in information-blocking behaviors that directly maximize short-term revenue. Our respondents reported that EHR vendors deploy products with limited interoperability and charge providers high fees unrelated to the actual cost to deliver those capabilities or refuse to support information exchange with specific EHRs and HIEs.”
Hospitals and health systems likewise utilize information blocking as a means to prevent clients from seeking services elsewhere to keep from losing out to the competition.
“In our results, the most commonly reported forms of information blocking among hospitals and health systems point to their interest in strengthening their competitive position in the market by controlling patient flow, which has been reported in other studies,” they wrote.
Furthermore, EHR vendors participating in information blocking and hospitals doing the same may together be collaborating to increase competitive advantage even more, perpetuating a cycle of information blocking with profitable results.
“A hospital or health system seeking to control market share would not be unhappy with an EHR vendor that charges high prices for HIE with other vendors because both stakeholders benefit from the resulting scenario where affiliated providers choose to adopt the vendor's product,” noted researchers. “This dynamic may also help explain why providers purchase EHRs that do not readily enable HIE.”
While policymakers have made attempts to mitigate instances of the limited health data exchange among EHR developers, their legislative efforts have fallen short of coercing vendors to eschew the practice.
“Increasing transparency of EHR vendor business practices and product performance, stronger financial incentives for providers to share information, and making information blocking illegal were perceived as the most effective policy remedies,” wrote researchers.
Adler-Milstein & Pfeifer determined new legislation and enforcement actions that deliver a strong message to EHR vendors are necessary to eliminate the issue.
“Our results have direct policy implications,” they wrote.
Nudging policymakers to take stronger action against EHR vendors and health systems repeatedly engaged in information blocking could spur more progress in EHR interoperability moving forward and in turn improve health data exchange industrywide.
“Current ONC efforts and bills in Congress pursue enforcement by authorizing the OIG to investigate and establish deterrents to information blocking,” researchers concluded. “If successful, reducing information blocking will help ensure that data follow patients across provider organizations, which is essential to improving the quality and efficiency of care.”