ONC Says Interoperability Slowed By Health Information Blocking

By Megan Williams, contributing writer

Interoperability by definition relies on the free flow on health information. While regulations such as the Health Insurance Portability and Accountability Act (HIPAA) and other security requirements have been accused of slowing down the free and productive use of data in healthcare, the Office of the National Coordinator for Health IT (ONC) has taken time out to address Congress about a different impediment — entities engaging in information blocking.

According to the ONC blog on their recent report to Congress, “health information blocking” happens when “persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information.” Some of the most well-known examples involve health IT developers engaging in activity including holding patient data “hostage,” charging fees (frequently per-transaction) to exchange information, or competing electronic health records (EHR) companies creating systems that intentionally do not communicate with one another.

The Issue Of Information Blocking

The report is careful to distinguish between intentional information blocking and other forms of activity that may result in the blockage of information — this includes technical and practical issues that are “beyond the control of any individual actor,” and frequently fall under the umbrella of “inefficient and uncoordinated behavior.”

Elements and behaviors that do raise concerns include:

• restriction of individual access to electronic health info via contract terms, policies, or organizational practices
• charging fees or inflating prices for data exchange, portability, and interfaces that make exchanging information cost prohibitive
• developing IT solutions that will deliberately and substantially increase the complexity, costs, or burden of sharing information, especially in relationship to adhering to interoperability standards
• developing or implementing health IT in ways that will likely “lock in” electronic health information or users

The report also provides empirical data around health information exchange.

The Solution

ONC and other federal agencies plan on taking several actions to address parts of the information blocking issue. These actions include:

• proposing new certification requirements with the goal of strengthening certified health IT capabilities “in the field”
• proposing new transparency obligations for developers to increase visibility of their restrictions, limitations, and other costs
• partnering with the Centers for Medicare and Medicaid Services (CMS) to coordinate healthcare payment incentives that reward interoperability and discourage information blocking

helping law enforcement agencies at both the federal and state level to investigate information blocking cases