A newly-released study suggests that both EHR vendors and providers may still be interfering with the free exchange of patient healthcare data. The researchers concluded that despite the hearty disapproval of both Congress and healthcare providers, the two still consider “information blocking” to be in their financial interest.
To conduct the study, which appears in this month’s issue of The Milbank Quarterly, researchers conducted a national survey between October 2015 and January 2015. Researchers reached out to leaders driving HIE efforts among provider organizations. The study focused on how often information blocking took place, what forms it took and how effective various policy strategies might be at stopping the practice.
It certainly seems that the practice continues to be a major issue of concern to HIE leaders. Eighty-three percent of respondents said they were very familiar with information blocking, while just 12 percent reported having just some familiarity with the practice and 5 percent said they had minimal familiarity. On average, the respondents offered a good cross-industry view, having worked with 18 EHR vendors and with 31 hospitals or health systems on average.
Forms of Blocking:
If the research is accurate, information blocking is a widespread and persistent problem.
When questioned about specific forms of information by EHR vendors, 29 percent of respondents said that vendors often or routinely roll out products with limited interoperability capabilities. Meanwhile, 47 percent said that vendors routinely or often charge high fees for sharing data across HIEs, and 42 percent said that the vendors routinely or often make third-party access to standardized data harder than it needs to be. (For some reason, the study didn’t mention what types of information blocking providers have instituted.)
Frequency of blocking:
It’s hardly surprising that most of the respondents were familiar with information blocking issues, given how often the issue comes up.
In fact, a full fifty percent said that EHR vendors routinely engaged in information blocking, 33 percent said that the vendors blocked information occasionally, with only 17 percent stating that EHR vendors rarely did so.
Interestingly, the HIE managers said that providers were also engaged in information blocking, though fewer did so than among the vendor community. Twenty-five percent reported that providers routinely engage in information blocking, and 34 percent saying that providers did so occasionally. Meanwhile, 41 percent said information blocking by providers was rare.
Motivations for blocking:
Why do HIE participants block the flow of health data? It seems that at present they get something important out of it, and unless somebody stops them it makes sense to continue.
When it came to EHR vendors, the respondents felt that their motivations included a desire to maximize short-term revenue, with 41 percent reporting that this was a routine motivation and 28 percent that it was an occasional motivation. They also felt EHR vendors blocked information to improve the chances that providers would choose their platform over competing products, with 44 percent of respondents saying this was routine and 11 percent that it was occasional.
Meanwhile, they believed that hospitals and health systems, the most common motivation was to improve revenue by strengthening their competitive advantage, with 47 percent seeing this as routine and 30 percent occasional. Also, respondents said providers wanted to accommodate priorities other than data exchange, with 29 percent seeing this as routine and 31 percent occasional.
So what can be done about vendor and provider information blocking? There are a number of ways policymakers can get involved, but few have done so as of yet.
When given a choice of policy-based strategies, 67 percent said that making this practice illegal would be very effective. Meanwhile, respondents said that three strategies would be very or moderately effective. They included prohibiting gag clauses and encouraging public reporting and comparisons of vendors and their products (93 percent); requiring stronger demonstrations of product interoperability (92 percent) and national policies defining policies and standards for core aspects of information exchange.
Meanwhile, when it came to reducing information blocking by providers, respondents recommended that CMS roll out stronger incentives for care coordination and risk-based contracts (97 percent) and public reporting or other efforts shining a spotlight on provider business practices (93 providers).