The Centers for Medicare and Medicaid Services (CMS) has come up with an interesting new strategy for improving interoperability, even if it would have Avon Barksdale from The Wire shaking his head in disgust.
According to a report in Modern Healthcare, the strategy would have people send emails to firstname.lastname@example.org and expose data blocking practices they’ve encountered. In other words, CMS wants vendors, providers, patients, and other stakeholders to snitch.
— HHS IDEA Lab (@HHSIDEALab) June 2, 2015
CMS’ Acting Administrator Andy Slavitt announced the proposal at Health Datapalooza in Washington D.C. He said CMS would act on the emails. It’s unclear if this means going after the named information blockers, but one thing has become increasingly clear, CMS is not messing around. Whether it’s through proposed rules and new laws, prospective challenges, speeches or reports, the administration has made improving interoperability its number one mission in 2015. It’s so prevalent that President George W. Bush, in the rare instance where he talked healthcare, had a tough time saying the word at HIMSS 2015.
Ending information blocking has become a major part of that strategy, with the phrase having come to prominence after an April report highlighted CMS and the Office of the National Coordinator’s (ONC) disgust for the practice. The report listed anecdotal evidence that suggested EHR application developers were breaking several of the rules in this regard.
Using interviews with people at regional extension centers (RECs), the authors detailed complaints from industry sources on how developers are charging fees that make it cost-prohibitive to send, receive, or export electronic health information stored in EHRs. The report said that some EHR developers were charging a substantial transaction fee any time a user sends, receives, or queries a patient’s electronic health information.. A variation in prices suggested that some are taking advantage of the situation.
The report also called out providers that have been information blocking. It said that hospitals and health systems often engage in information blocking to maintain their market dominance.
What’s clear, and my colleagues Mark Hagland and Rajiv Leventhal have written about this, is that figuring out what constitutes as unforgivable information blocking is still unclear. In an accompanying blog with the report, National Coordinator for Health IT Karen DeSalvo, M.D. talked about how health IT developers impose contractual restrictions that prohibit customers from reporting or even discussing costs, restrictions, and other relevant details.
As Hagland noted in a recent blog, told through the words of the wise Julia Adler-Milstein, Ph.D., the challenge to stopping information blocking is figuring out when it’s happening. This explains CMS’ strategy in getting people to email them about instances where it occurred to them. Even with the report they released in April, they’re still figuring this out too.
Leventhal recently interviewed University of Texas Health School of Biomedical Informatics professor Dean F. Sittig, Ph.D., who said the blocking is coming more from the providers than vendors. “It’s happening and it would be better for the patients if it wasn’t happening, but there is a huge business around this. It’s not completely about patient care. These are multi-billion dollar businesses. If we shared all the data that people want us to share, we would lose a significant amount of revenue, so much so that it would make us a lot smaller, maybe even put us out of business. Until that changes, and there are federal laws that people are talking about now, we won’t have interoperability,” Sittig told Leventhal.
Adding to the discussion is the proposed 21st Century Cures Act and Burgess Bill from Congress, which would impose penalties on the information blockers. This legislation got John Halamka, M.D., vice chair of the Health IT Standards Committee (HITSC), and CIO of the Beth Israel Deaconess Medical Center to compare “information blocking” to the Loch Ness Monster, often talked about but seldom seen.
So is it vendors or providers? Is it an over-hyped problem or does it happen a lot? It’s hard to tell. The best way to understand this is through one of the proposals in the April report. ONC suggested transparency obligations for health IT developers that require disclosure of restrictions and costs associated with interoperability. Transparency is another key word in CMS’ world these days. This week alone, the agency publicized physician and supplier utilization and payment data and released claims data for innovators.
In my view, if the smoke around information blocking is indeed a fire, it’s time for that knowledge to become public. More than just having them disclose the costs associated with interoperability, let’s expose the vendors (and providers) that are doing it (if they are doing it). It’s time for transparency to take hold.
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