Information Blocking by EHR Vendors, Health Systems Still Prevalent

Even with information blocking regulations looming, health systems and EHR vendors are still conducting information blocking practices, according to a study published in the Journal of the American Medical Informatics Association (JAMIA).

The ONC final interoperability rule defines information blocking as the intentional withholding of patient health information either from provider to provider or provider to patient. This has long been a touchy subject, with some industry experts questioning what exactly qualifies as “intentional.”

With health systems and EHR vendors attempting to achieve interoperability and effective patient data exchange, both actors have encountered numerous challenges on the road to connectivity.

For health systems, seamless patient data exchange can allow competitors to own the market share by facilitating access to patients' prior medical history. Meanwhile, EHR vendors are able to increase costs, such as connectivity charges, since the prices are already high for health systems to switch EHR vendors, the research team said.

The researchers also noted limiting patient data exchange between outside vendors may make it more difficult for providers to switch between EHR vendor systems. Thus, government incentives can result in information blocking practices.

The study authors surveyed 106 HIEs because they are directly connected to both providers and EHR vendors. HIEs observe both of these actors’ behaviors and can assess interoperability and patient data sharing issues.

The researchers asked the HIEs three questions:

• How often do EHR vendors and health systems practice information blocking?
• How are these information blocking practices conducted?
• What is the impact of local market competitiveness on information blocking behavior?

Fifty-five percent of HIE respondents reported EHR vendors at least sometimes engaged in information blocking. Thirty percent of HIEs said health systems at least sometimes engaged in information blocking. Meanwhile, 14 percent of HIEs reported all EHR vendors engaged in information blocking.

According to the respondents, 42 percent of HIEs said EHR vendors engaged in setting unreasonably high prices, which was the most common information blocking behavior. Twenty-three percent of HIEs reported artificial barriers as the second most common behavior among vendors.

For health systems, 15 percent of HIEs reported refusal to exchange information as the most common barrier, while only 10 percent said artificial barriers were a barrier.

HIEs noted greater developer competition as a direct correlation to higher information blocking levels.

In more competitive developer markets, 47 percent reported high levels of information blocking by EHR vendors, while 31 percent reported high levels of information blocking by health systems.

“Reduction in information blocking behaviors is therefore a critical component of policy efforts to facilitate greater sharing of patient information,” wrote the study authors. “As enforcement of the new regulations begins, surveillance of stakeholders with knowledge of information blocking, including HIEs, will be critical to identify where reductions occur, where information blocking practices persist, and how best to target continued efforts.”

The study authors noted the findings were similar to a 2016 information blocking survey. That survey found EHR vendors were more likely to engage in information blocking than health systems, but both actors engaged in the practice. Both surveys provide a consistent baseline and the consistency proved information blocking still continues after five years.

“Given persistently high levels of information blocking reported by knowledgeable actors, our findings support the importance of defining and addressing it through the planned implementation of the final regulation, definition of penalties, and enforcement for those found to engage in information blocking,” the researchers wrote. “Our findings also provide insight into how enforcement efforts might be targeted and one useful approach to monitoring their effectiveness.”

The study insights are essential for health IT professionals to dissect and determine the impact of regulations on both complex and universal interoperability barriers.

“As regulation in this area continues, these measures will indicate whether information blocking activities are decreasing, and in particular whether the rate of change in information blocking varies across the different actors that might engage in information blocking, the specific forms they pursue, and the dynamics of local markets that may alter incentives to block information,” concluded the study authors.