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ONC steps up campaign against information blocking

With their new vendor pledge against information blocking, HHS and ONC have stepped up their campaign against the alleged practice by some EHR vendors and healthcare providers.

LAS VEGAS -- Amid the private sector frenzy of new product announcements and dealmaking, HIMSS 2016 was marked by a vigorous thrust by federal healthcare and health IT officials against the alleged practice of information blocking.

That campaign, which is part of a larger effort to promote health data interoperability, shows no signs of abating -- even during the Obama administration's last months and as questions mount about the future of meaningful use.

Department of Health and Human Services (HHS) Secretary Sylvia Burwell's attack on information blocking on the eve of the annual Health Information Management Systems Society conference was the latest federal fusillade against the purported scourge.

In her keynote to a packed HIMSS convention hall, Burwell also unveiled a surprise health IT industry pledge against information blocking, signed by most major vendors and some of the country's biggest healthcare providers.

During the weeklong show in Las Vegas, Office of the National Coordinator for Health IT (ONC) officials continued to disseminate Burwell's message. "We fervently believe that information must flow," Andy Gettinger, M.D., ONC's chief medical information officer, and acting director of the Office of Clinical Quality and Safety, said during an ONC panel on EHR usability, safety and information blocking. "It must flow first for patient care."

While maintaining the federal policy of not naming specific perpetrators, Gettinger said ONC has seen "lots of examples" of information blocking, adding that ONC refers individual cases to HHS' Office for Civil Rights (OCR) for investigation.

What is information blocking

ONC defines information blocking as "when persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information."

According to Gettinger's HIMSS 2016 presentation, examples of information blocking are:

  • Opportunistic pricing or fees that make exchanging information cost-prohibitive;
  • Contractual  terms or restrictions that interfere with information sharing or patients' access to their electronic health information;
  • Implementing technology or policies that are likely to "lock in" users or information;
  • Inappropriately citing HIPAA as a reason not to share information;
  • Blocking information as a business practice to control referrals, consolidate markets or exclude competitors; and
  • Implementing health IT in nonstandard ways, or erecting unnecessary technical barriers to health information exchange.

After HIMSS 2016, an ONC spokesman elaborated on the agency's posture toward information blocking in an email to SearchHealthIT.

We fervently believe that information must flow.
Andy GettingerM.D., chief medical information officer at ONC

The ONC official said while the agency has received "credible complaints" about information blocking, ONC is not a law enforcement agency and does not have authority to formally investigate, conduct hearings or publicly declare an organization has engaged in information blocking.

In fact, the official said, no federal agency -- even OCR -- has that authority. And so "credible complaints of information blocking often go without investigation, and those who engage in this conduct often do so with impunity," even though "we have defined information blocking and the health IT industry has accepted that definition."

Nevertheless, OCR does investigate some information-blocking complaints, though so far, none have resulted in fines or other disciplinary action.

Also, President Barack Obama recently submitted proposed legislation to Congress calling for the HHS Office of Inspector General (OIG) to be given the authority to investigate and prosecute providers and technology vendors who engage in information blocking.

OIG last year issued an alert linking information blocking to the federal antikickback statute, suggesting that, contrary to some health IT observers' conviction that the new anti-information blocking pledge is not enforceable, the federal government may,  indeed, be able to crack down on the alleged practice.

Another indication that federal officials are serious about information blocking is OCR's recent guidance on HIPAA's provisions on patients' rights to quickly obtain a complete record of their own health information. OCR clarified that HIPAA not only protects patient's health privacy, but also mandates they get timely access to their records.

Information blocking was first broached as a major health IT issue a year ago, when ONC issued a report to Congress on the practice a few days before HIMSS 2015. The document didn't specifically name culprits, but was widely seen as a shot at EHR giant Epic Systems Corp., and at large, also unnamed provider systems.

Next Steps

ONC's information-blocking report to Congress

What is interoperability?

Interoperability problems in healthcare

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