ONC rebukes information blocking on eve of HIMSS 2015

Contracts and pricing earn scrutiny

Information blocking can come in several forms, particularly as it restricts the free exchange of clinical information, Jodi Daniel, director at the ONC Office of Policy, said in a media call Friday morning. Examples Daniel and the report mention include:

• Contractual restrictions with vendor products that limit sharing, including certain warranty cancellation clauses
• Opportunistic pricing that makes information sharing cost prohibitive, such as contracts that lock in customers and potentially prevent them from switching to better technologies
• Technological obstacles and non-standard approaches that make it difficult for providers to export electronic information to another EHR system

The technological aspect, if found to be prevalent, offers an interesting topic for lawmakers to debate, Leslie Krigstein, director of congressional affairs at the College of Health Information Management Executives, told SearchHealthIT.

"What will Congress tolerate if interoperability challenges are largely technical barriers?" Krigstein said.

Certain limits to information are not considered information blocking, however, such as some related to privacy laws or patient safety, Daniel said.

DeSalvo: More evidence is needed

Interestingly, much of the report stems from anecdotal evidence and public testimony, rather than hard facts.

"We don't have a lot of quantified information so far," Karen DeSalvo, M.D., national coordinator for health information technology, said during the press call. "We do propose some ways we can advance our understanding of how prevalent the challenges are."

ONC will work with lawmakers, law enforcement, and other federal agencies to crack down on information blocking. The report does not address any whistleblowing provisions, Daniel said.

We don't have a lot of quantified information so far.

Another action officials plan to take is already in the works, as ONC's recent proposed rulemaking on EHR and interoperability certification includes two related requirements:

• Surveillance to better identify technical barriers to information sharing within vendor products
• Requirements for pricing and contract transparency

It's not just Epic on notice

Many observers will assume the ONC report pokes at Epic Systems Corp., whose EHR technology has a reputation for not working well with other vendors' offerings in terms of interoperability.

However, the report does not name Epic, nor does it just target vendors, Krigstein said. The report also takes into account providers that engage in information blocking, whether intentional or as a byproduct of business practices that seek to maximize Medicare and Medicaid reimbursement.

For example, some accountable care organizations (ACOs) are motivated to keep the sickest patients out of their systems because ACOs get paid for positive medical outcomes -- in other words, treating the healthiest patient populations.

Conversely, many providers still enjoy financial incentives to retain the sickest patients because the federal reimbursement system up to now has been dominated by a fee-for-service model -- that is, performing the most procedures and diagnoses. However, fee-for-service is eroding quickly under federal value-based reimbursement guidelines, and ONC's response to Congress reflects the new realities of that changing terrain, Krigstein said.

"We're happy they put the report out and happy to see the emphasis on information blocking," Krigstein said. "Certainly it's timely. But it's just the beginning of the conversation. Congress will take note of it and it will be a topic of conversation moving forward."

SearchHealthIT News and Features Writer Shaun Sutner contributed to this article.

Have you encountered obstacles to EHR interoperability? Let SearchHealthIT News Director Scott Wallask know by email at swallask@techtarget.com, or post something to him on Twitter @Scott_HighTech.