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HHS Called on to Eliminate Health Information Blocking

A coalition of stakeholders seeks a more focused approach to ending health information blocking to improve interoperability at HHS.

Health Information Blocking

Source: Thinkstock

By Kate Monica

- A coalition of healthcare stakeholders convened by Health IT Now called HHS and its departments to eliminate information blocking so that providers can effectively aggregate patient EHRs and advance interoperability.

The letter from organizations including the American Academy of Family Physicians (AAFP), AMIA, DirectTrust, and athenahealth requested HHS issue a proposed rule that takes existing laws, standardization, patient health data access, and other complicating factors into consideration.

Undersigned organizations drew up the recommendations during an information blocking workgroup summit hosted by Health IT Now on July 25, 2017.

“This business practice barrier to interoperability does not just thwart federal and private efforts to more fully share clinical information, it may pose significant risk to patient safety,” stated the letter. “For instance, information blocking impedes provider access to the most current, accurate, or complete information on their patients.”

Incomplete patient EHRs can lead to gaps in information and inhibit accurate patient care delivery.

The coalition pointed to existing provisions in the 21st Century Cures Act as being potentially effective in eliminating information blocking, but stated provisions need to be clearer and more targeted.

“The 21st Century Cures Act prohibits information blocking and allows for penalties to be placed on vendors and providers who violate the prohibition,” wrote stakeholders. “The law, if implemented correctly, can facilitate the sharing of information to both enhance personalized care, as well as strengthen the growing population health model of coordinated high-quality care.”

To address any potential challenges to implementing provisions in the 21st Century Cures Act, the coalition recommended HHS solicit feedback from a broad range of stakeholders.

Specifically, the coalition urged HHS to answer the following questions to clarify the extent of certain provisions and how these provisions will affect healthcare organizations: 

  • What is information blocking and what is not?
  • What constitutes “special effort” in eliminating blocking and promoting interoperability?
  • How ought "should have known" be defined?
  • How should patient access be measured?
  • How does the law interact with existing laws like HIPAA and medical malpractice?

Furthermore, Health IT Now and other undersigned organizations requested HHS incorporate policy considerations including the following:

  • What is standard vs. non-standard implementation?
  • The statute institutes penalties on vendors up to $1 million per violation. How should "per violation" be defined?
  • What constitutes a "complete record"?
  • How should the ONC Certification Program be updated to reflect the new requirements?
  • Should there be a reporting mechanism for government information blocking? 

The coalition proposed a discussion session with HHS officials in September to address these and other questions and provide input on the development of a proposed rule.

“We stand ready to assist in the implementation this complex law, and to take the needed steps to put an end to information blocking,” stated the letter.

“This is a good way for various stakeholders to show our solidarity in ending this practice that is affecting the healthcare industry at large and placing patient lives at risk,” it concluded.

Health IT companies are vocal about the dangers of information blocking, though progress in entirely eradicating the practice has been slow.  

Cerner Vice President of Interoperability Kashif Rathore cited information blocking as one of the most troubling barriers to interoperability.

“We run into instances where the health organizations and other vendors may think this is their data and may use this for competitive reasons,” said Rathore. “That mindset isn’t good because it’s not helping the patients.”

“Interoperability needs to become a utility, and not used for anyone’s competitive advantage,” he added.

A study earlier this year found information blocking is still commonplace.

Researchers at University of Michigan Schools of Information and Public Health used a national survey of 60 HIE leaders and found about half of respondents had engaged with health IT companies participating in information blocking. A quarter reported hospitals and health systems were engaging in the practice.

Stronger, more targeted policies to end information blocking could help to accelerate progress toward eliminating the practice entirely. 

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