Some health IT vendors and health care providers are intentionally blocking the sharing of patient information, impeding progress toward a national data sharing goal, according to a report by the Office of the National Coordinator for Health IT, the Wall Street Journal reports.

Background

Under the 2009 economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments. According to the Journal, the incentive payments have helped nearly 80% of eligible professionals and 60% of eligible hospitals convert from paper files to EHRs. However, just 20% to 30% of providers are able to share EHRs with outside providers, according to the Journal.

Report Details

The report was written in response to a December 2014 request from Congress (Beck, Wall Street Journal, 4/10). 

For the report, ONC examined allegations that some health IT developers and providers have engaged in "information blocking," which ONC describes as a practice in which "persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information" (DeSalvo/Daniel, Health IT Buzz, 4/10).

Report Findings

In the report, ONC listed several complaints that it has received, including that vendors have:

• Charged high fees to establish connections and share patient records;
• Required customers to use proprietary platforms; and
• Made it prohibitively costly to change EHR systems.

Further, the report found that many hospital systems complicate the transfer of patient records to rival providers to control referrals and enhance market dominance.

The report noted that ONC does not have the authority to regulate prices and that many of the actions in question do not violate laws. The agency wrote that it could decertify EHR systems that intentionally block data sharing but warned that doing so would wrongly penalize customers (Wall Street Journal, 4/10).

ONC wrote, "While many stakeholders are committed to achieving this vision, current economic and market conditions create business incentives for some persons and entities to exercise control over electronic health information in ways that unreasonably limit its availability and use." It added, "These concerns likely will become more pronounced as both expectations and the technological capabilities for electronic health information exchange continue to evolve and mature" (Miliard, Healthcare IT News, 4/10).

Recommendations

ONC outlined several actions that can be taken to address information blocking, including:

• Assisting federal and state law enforcement agencies in identifying information blocking cases that violate current laws;
• Bolstering oversight of certified health IT capabilities "in the field" through new requirements;
• Creating a nationwide health information exchange governance framework;
• Requiring certified health IT developers to disclose additional costs, limitations and restrictions associated with their products;
• Working with CMS to create incentive payments that reward interoperability and health data sharing; and
• Working with HHS' Office for Civil Rights to educate stakeholders on how HIPAA privacy and security standards apply to information sharing (Health IT Buzz, 4/10).

Reaction

The Electronic Health Record Association, a trade organization, said that its members aim to share patient records but that it requires time and money to build connections used by several different stakeholders.

Meanwhile, some vendors have said they do not depend on connection fees. For example, vendors in the CommonWell Health Alliance -- which comprises about 70% of the acute care market and 24% of the ambulatory care market -- say they seek to create a network with low-cost connections that make it easy for physicians to find patient records throughout the system (Wall Street Journal, 4/10).