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EHR Association Calls ONC Information Blocking Report into Question

October 19, 2015
by Rajiv Leventhal
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The HIMSS EHR Association (EHRA) has issued a response to the Office of the National Coordinator for Health IT’s (ONC) report on information blocking that it released this past April.

The April ONC report detailed several examples of electronic health record (EHR) developers and health systems blocking health information sharing between each other. The act of information blocking occurs when an entity or person knowingly and unreasonably interferes with the exchange of electronic health information.

Using interviews with people at regional extension centers (RECs), the authors of the report 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. Some EHR developers even charge a substantial transaction fee any time a user sends, receives, or queries a patient’s electronic health information, the report said.

The EHRA, comprised of nearly 40 electronic health record vendors, reviewed the report, and in a letter to ONC, said it generally agreed with the definition and characteristics of information blocking, including the three-part test of interference, knowledge, and lack of reasonable justifications. However, the EHRA urges caution when labeling a fee as cost-prohibitive and, therefore, information blocking.  “Costs are not limited to fees that a developer might charge for interfaces and interoperability services, but also include the providers’ resources to deploy and maintain those interfaces,” the letter stated.

It continued, “Costs must be evaluated in the context of the difficulty of developing and maintaining the interface, the number of potential users of that interface, the compliance with certification standards by the exchange partner, and the value gained from the data exchange. As providers’ processes further align to support consistent data exchange and as standards are harmonized around the content and methods of data exchange, it is reasonable to expect that overall interoperability-related costs may go down, but will not disappear entirely.”

What’s more, EHRA said that determining what crosses the information blocking threshold is challenging, requires careful consideration, and will be very situation-specific.  It gives an example of a hospital that has received two separate requests to connect: one is from a local provider from whom they receive frequent referrals; the other request is from a provider several states away with infrequent patient referrals. “If the hospital prioritizes the local provider to connect now and indicates they will work with the remote provider at a future date, is the hospital engaging in “information blocking”? Or is this considered a reasonable justification?” the letter asked.

As the ONC report indicates, there are a limited number of anecdotes of information blocking, but determining which are truly information blocking per the definition is not easy, EHRA said. “Any assessment of potential information blocking must be fact-based, given a specific situation, and include the perspectives of all stakeholders before declaring that information blocking has, in fact, occurred.  The EHRA recognizes the perception that information blocking exists, but submits that, in many cases, there is no intent to interfere, but rather a series of events that result in less data exchange than desired by some parties.”

Further, EHRA suggested that the ONC report creates a mistaken impression that areas where there are low levels of information sharing constitute information blocking.  As such, “The EHRA urges ONC to be clear on the distinction between low rates of data sharing because of the lack of a return on investment or immature infrastructure to enable clear focus and context.”

It concluded, “the concept of ‘information blocking’ is still very heterogeneous, mixing perception, descriptive, and normative issues in ways that are not easily untangled.  As a result, this concept and ‘label’ does not provide a good basis yet for policy actions or enforcement, as it could encompass a broad range of actions, few of which are likely to warrant civil or other penalties.”

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