- Data blocking, the antithesis to health IT interoperability, is emerging as a major impediment to the improvement of EHR use. Data blocking is defined by the ONC as preventing the sharing of health information intentionally, knowingly, or with a lack of reasonable justification for blocking the information.
For example, excessive fees associated with transferring medical records can qualify as data blocking. Data blocking is a clear hurdle in the way of full interoperability because it is intentional, and therefore can be preventable. This not only bars the free exchange of information, but also the benefits that go with it—care coordination, patient engagement, and team-based care.
Throughout the course of the past year, several healthcare stakeholders have taken a stand against data blocking in the name of full, nationwide interoperability. Between industry reports on the issue and Congressional attention, data blocking has been thrust to the forefront in an effort to increase overall information sharing.
However, it should be noted that not everyone in the industry believes data blocking is a major issue. In October, the HIMSS EHR Association (EHRA) released a statement explaining that data blocking is not as well-defined as many claim. For example, the association explained that the charging of fees for data exchange is not data blocking, contrary to common opinion:
Costs are not limited to fees that a developer might charge for interfaces and interoperability services, but also include the providers’ resources to deploy and maintain those interfaces. Costs must be evaluated in the context of the difficulty of developing and maintaining the interface, the number of potential users of that interface, the compliance with certification standards by the exchange partner, and the value gained from the data exchange.
Despite the conflicting ideas, several key stakeholders have pushed forward with efforts to ensure that data blocking never becomes a major impediment to patient care. Below is a round-up of some of the biggest moves made against data blocking in 2015:
ONC publishes report on data blocking
ONC has taken a large role in putting an end to data blocking, foremost by publishing its data blocking report to Congress.
ONC sent this report per Congressional request, and explained the negative impacts that data blocking can have on the healthcare industry. In fact, the agency presented to Congress several instances that would qualify as data blocking:
Contract terms, policies, or other business or organizational practices that restrict individuals’ access to their electronic health information or restrict the exchange or use of that information for treatment and other permitted purposes
Charging prices or fees (such as for data exchange, portability, and interfaces) that make exchanging and using electronic health information cost prohibitive
Developing or implementing health IT in non-standard ways that are likely to substantially increase the costs, or burden of sharing electronic health information, especially when relevant interoperability standards have been adopted by the Secretary
Developing or implementing health IT in ways that are likely to “lock in” users or electronic health information; lead to fraud, waste, or abuse; or impede innovations and advancements in health information exchange and health IT-enabled care delivery
Most common instances of information blocking, according to the ONC, are targeted toward the health IT developer. For example, most reports allege that EHR vendors create systems that will not exchange information with certain other systems. Additionally, IT developers can tack on fees for sharing information, creating a cost barrier to information sharing.
"Most complaints of information blocking are directed at health IT developers," the ONC explained. "Many of these complaints allege that developers charge fees that make it cost-prohibitive for most customers to send, receive, or export electronic health information stored in EHRs, or to establish interfaces that enable such information to be exchanged with other providers, persons, or entities."
OIG steps in with data blocking consequences
The Office of the Inspector General (OIG) also stepped in by describing data blocking and how it plays into the federal anti-kickback statute relative to health IT and EHR use.
Specifically, the Inspector General Daniel Levinson posted on HealthITBuzz.com about the OIG’s EHR safe harbor. This safe harbor states that under certain parameters, providers can accept EHRs as donations from vendors. The OIG reportedly intended this safe harbor to foster the adoption of health IT and to rid providers of penalizations they would otherwise face under the anti-kickback statute.
However, Levinson continued to explain that engaging in data blocking violated the parameters of the safe harbor, in turn violating the anti-kickback statute:
If a donor, or someone on the donor’s behalf, takes any action to limit or restrict the use, compatibility, or interoperability of the donated items or services with other electronic prescribing or EHR systems, the donation arrangement would not receive safe harbor protection and would be suspect under the Federal anti-kickback statute.
By issuing this warning, Levinson and the OIG established certain expectations for those providers receiving donated EHR systems. Furthermore, it reinforced the definition of data blocking and highlighted the detrimental side effects it has on interoperability.
Congress makes moves against data blocking
The Senate has also investigated the issue of data blocking, with the committee on Health, Education, Labor, and Pensions hearing from expert witnesses during a Congressional hearing this past summer.
One of the four witnesses, DirectTrust President and CEO David Kibbe, MD MBA, explained that the government had a crucial role in incentivizing information sharing and penalizing data blocking.
“While the responsibility for assuring secure interoperable exchange resides primarily with the health care provider organizations, and not with the EHR (electronic health record) vendors nor the government, I strongly believe there is a role for government to encourage and incentivize collaborative and interoperable health information exchange,” Kibbe said.
One change Kibbe suggested was the shift from fee-for-service payments to value-based payments. Because physicians were previously paid for the number of services they provided, they had an unwillingness to share patient information and collaborate with other providers. As the industry shifts to a payment model more based in quality of care, providers may be incentivized to share information for the betterment of a patient’s health.
"Changes to these payment incentives could do much to reward business models where collaboration and interoperability are highly valued, and where the technological capabilities, standards, and infrastructure for interoperable health information exchange now in place would be put to much better use,” Kibbe concluded.
While the future of health IT and information sharing is certainly evolving, it is clear that data blocking is on key stakeholders’ radars. With Congress, ONC, and OIG continuing to tackle the issue, as well as policies such as meaningful use encouraging interoperability, perhaps the healthcare industry will see data blocking decline in the future.