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How Do Different Health Industry Experts View Data Blocking?

Some healthcare experts' views on data blocking diverge, with some seeing an imminent threat and others a more nuanced situation.

By Sara Heath

- As the healthcare industry continues to put high priority on interoperability, it’s becoming clear that data blocking needs to end.

data-blocking

Health data experts are making stands against the practice, as made evident in the Office of the National Coordinator for Health IT’s Report to Congress on Data Blocking, released last year.

As a part of the report, ONC defined data blocking as knowingly withholding information without reasonable justification. The agency also used the platform to spell out specific instances of what constitutes as data blocking, such as exorbitant fees for patients to retrieve their health data.

ONC also addressed data blocking its most recent report to Congress. In the report, the agency cited information blocking as a key barrier to interoperability, explaining that other federal agencies in partnership with private stakeholders will need to develop narrower definitions of the practice in order to properly police information blocking.

“ONC has already taken steps to address information blocking, such as through new certification requirements that require more aggressive surveillance of certified health IT capabilities in the field and that require health IT developers to disclose additional information about health IT limitations and types of costs,” ONC reported.

READ MORE: Research on Health Information Exchange Limited, AHRQ Finds

“While these actions are important, preventing information blocking will require overcoming significant gaps in current knowledge, programs, and authorities that limit the ability of ONC and other federal agencies to effectively target, deter, and remedy this conduct,” the agency continued. “Most significantly, current law does not directly prohibit information blocking and provides no effective means to investigate and remedy it.”

However, not all healthcare professionals are viewing data blocking as such an imminent threat. In an October letter, the HIMMS Electronic Health Record Association (EHRA) stated that the ONC will need to further clarify instances of data blocking because as they were stated in their original report, they did not agree that they all were indeed that practice.

“When a vendor makes the certified capability available to a provider, but offers more advanced/innovative interoperability features for a fee, is it information blocking? When providers and vendors actively engage with reasonable and non-discriminatory practices, it is clear that no information blocking has occurred,” EHRA wrote. “However, establishing the contrapositive is challenging in a world of limited resources.”

Furthermore, the group stated that all assertions made about an instance of information blocking needed to be based within facts regarding the issue.

“Any assessment of potential information blocking must be fact-based, given a specific situation, and include the perspectives of all stakeholders before declaring that information blocking has, in fact, occurred,” EHRA stated.

READ MORE: AHA Calls for Data Blocking Clarification on Senate HELP Bill

Others have also nudged against the ONC’s stands against data blocking. In an op-ed published in Health Affairs last May, Julia Adler-Milstein, an assistant professor at the University Of Michigan School Of Information, said that it will be extremely difficult to prove reasonable justification for data blocking.

“The particularly tricky dimension is ‘reasonable’ justification,” she said. “There is no question that the CEO of a large electronic health record vendor would have quite a different definition of ‘reasonable’ than would our National Coordinator for Health IT.”

Other experts say that they had been viewing information blocking as a non-issue, and were surprised to realize that some in the industry were genuinely concerned about it.

In a sit-down with EHRIntelligence.com at HIMSS2016, Epic Systems’ founder and CEO Judy Faulkner went on the record to say that she hadn’t considered data blocking as a real issue until she had gone to the conference.

“Up until this morning, I would have said I have not seen data blocking,” she said.  “We don’t do data blocking.  We have not worked with a vendor who does data blocking.”

READ MORE: athenahealth Leads Epic, Cerner in Ease of EHR Data Sharing

Faulkner said she doesn’t think the practice will prevail, if it’s an issue at all. “I think that’s something we’ll get over, too,” she shrugged. “It might just be an initial reaction to a new way of doing things.”

Some experts say that part of the issue with data blocking is that there are few incentives for sharing information. According to Ashley Thomas, a legal fellow at the Office of Legal Affairs at Presence Health in Chicago, EHR vendors are trying to survive in an ultra-competitive industry. Data blocking, to whatever extent it takes place, is happening so that these companies can stay afloat.

“There isn’t sufficient justification or fiscal incentives for information sharing,” Thompson wrote in an article last year. “Vendors and providers that contain the exchange of electronic health information to only their network of providers are trying to protect their economic interests and may not agree that they are blocking information. The government needs to create incentives around these referrals to enable the exchange of information out-of network.”

Considering the fact that so many industry experts view information blocking as a complicated issue, it is clear that further collaboration is needed. For what it’s worth, ONC has made substantial headway in bringing the topic to the forefront. Going forward, the agency might need to consult with more organizations – both public and private – to better understand the best course of action against this practice.

That’s what Adler-Milstein said in her op-ed. The health data expert said that this effort will need to include more stakeholders in order to get to the bottom of the real issue.

“And to begin with, there is no statutory basis on which to investigate and go after information blocking; today, these practices are, for the most part, completely legal,” Milstein said. “How to navigate these intertwined challenges is a critical unresolved issue, particularly so given the fact that ONC has the ability to take some actions to curb information blocking, but stronger action would require collaboration among a broader set of federal agencies and even new legislation.”

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