With the continued integration of technology into every phase of healthcare, information blocking remains an issue. Although many challenges remain, there are signs this controversial practice could be nearing its end.
The main issue with sharing information rests in the structure of how data is stored and its integrity maintained. There is no one, universal system all healthcare providers use to store and update electronic healthcare records (EHRs).
To facilitate the most accurate, up-to-date sharing of records with both medical professionals and patients, information must travel between disparate systems, but given the prevalence of data breaches, information blocking has become a complex issue.
A typical instance of information blocking occurs when someone, typically a vendor or provider, does not share information with another healthcare system.
There can be legitimate reasons for this. Information can be blocked over concerns about the security of the system requesting the information, for example. Patients may also be wary about releasing certain information, concerned it will be used for marketing purposes.
However, in some cases, a vendor blocks the sharing of information in an attempt to make a provider use a certain type of software or EHR system.
This hinders the overall goal of interoperability and is now being targeted by policymakers. Interoperability efforts are pushing closer to a data-driven system that experts believe will lead to better quality care and improved patient outcomes, but it all depends on data liquidity.
Government Regulations
Recognizing the need for laws and penalties to address information blocking, the U.S. Congress passed legislation in 2016 during the Obama Administration creating a framework for just that. The 21st Century Cures Act established penalties of up to $1 million for those who knowingly engage in information blocking without legitimate reasons.
The Office of the National Coordinator for Health IT (ONC) and the Department of Health and Human Services are currently working on regulations that will specify what constitutes a justifiable reason to engage in information blocking.
But while the healthcare industry awaits those mandates, other issues have arisen.
For example, a proposal to make interoperability mandatory for all billing for Medicare and Medicaid has met resistance from the American Hospital Association, among others. The hospital group’s chief concern is that not all hospitals have EHR records that meet the standards for interoperability.
They also highlighted the challenge of sharing data from discharged patients with post-acute medical providers, again because of disparate systems. They believe the rules would essentially amount to an unfunded mandate from the government.
Possible Solutions
While issues remain, the movement toward ending information blocking is gaining momentum. Writing for Forbes, Luis Castillo, CEO of health IT company Ensocare, wrote that speakers at the 2018 Health Information and Management Systems Society conference introduced “some of the most exciting tech developments I’ve ever seen.”
He added, “There’s a willingness to cooperate and a willingness to engage in [solving] these problems that is unlike anything I’ve witnessed before.”
Speaking at the event, CMS Administrator Seema Verma said that information blocking would not be tolerated: “We have also taken significant steps to make sure that providers and hospitals are not engaged in data blocking. It’s not acceptable to limit patient records or to prevent them and their doctor from seeing their complete history outside of a particular healthcare system.”
While the government is addressing information blocking done for the wrong reasons, the underlying technology challenge remains – the creation of fully interoperable, secure EHR systems across healthcare.
As noted by Castillo, a recent study found less than 30% of hospitals had the four key components of interoperability in place: data integration, reception, distribution and finding.
