ONC outlines plans to deter health information blocking

The ONC is planning to take action to enforce more open data sharing between systems to advance interoperability.

Health information blocking is the act of "knowingly and unreasonably interfering with the exchange or use of electronic health information," according to the ONC's 2015 Report to Congress on Health Information Blocking. Vendors or health systems sometimes refuse to release information through contractual restrictions or opportunistic pricing structures, which inhibit interoperability, said Jodi Daniel, director of the ONC's Office of Policy, in a media briefing.

The report outlines a number of steps the ONC has taken or plans to take to remedy the issue, including strengthening in-field surveillance by health IT certification inspectors, restricting the standards and implementation specifications for certified health IT, promoting transparency in health IT products and services and establishing governance rules that deter information blocking, according to the report.

The ONC plans to work in concert with the HHS Office for Civil Right to improve stakeholder understanding of HIPAA privacy and security standards related to information sharing to encourage more health IT vendors and providers to allow information exchange. The agency will also coordinate with the HHS Office of the Inspector General and CMS on matters concerning information blocking in the context of the federal Anti-Kickback Statute and Physician Self-Referral Law.

The report examined 60 unsolicited complaints of information blocking, the majority of which were directed at health IT developers. Most of the complaints had to do with providers being locked in through contracts of implementation and developers being unwilling to exchange information with unaffiliated providers. The ONC concluded from empirical research and the anecdotal complaints that "business and competitive motivations influence whether hospitals and hospital systems choose to exchange electronic health information with unaffiliated providers."

However, Ms. Daniel said the ONC compiled the report mostly through complaint reports, empirical reports and research, so the agency will need better metrics to understand and measure information blocking in the future.

"This is really the first comprehensive look that we have taken at health information blocking," Ms. Daniel said. "There are things we can be doing to more effectively address [health information blocking] and some actions that others can do to help meet the challenge."

Health information blocking does have its reasonable measures, Ms. Daniel said. Some providers or vendors may want to control the flow of information for privacy, patient safety or legitimate cost issues. The ONC's description limits the definition of blocking to unreasonable and knowing interference, which may not always be the case, she said. To enforce the unreasonable cases, there may have to be legal changes that allow agencies with enforcement power to step in, which may not be possible under current laws, she said.

Karen DeSalvo, MD, the National Coordinator of Health Information Technology, said in the media briefing that the report helps to define the tools the office has available to address health information blocking and what may need to be changed going forward. She did not outline specific policy changes that will be requested but said the agency will work with Congress to develop an enforcement measure for regulating the practice.

"This bears some activity on the Hill with regards to their interests in health information sharing," Dr. DeSalvo said. "We do believe that we have some shared goals with Congress and we're really looking forward to working with them to help identify the right solution."

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