CMS wants pathologists and other healthcare providers to report “every issue—small, medium and large,” when someone gets in the way of information sharing

Federal health officials are taking steps to end technology vendors’ “data blocking” practices that inhibit the electronic transfer of patient information. This is a tactic that has proven costly for pathology groups and clinical laboratories that want to interface their laboratory information systems with providers’ or hospitals’ electronic healthcare records (EHRs).

The fiscal year 2015 Omnibus Appropriations Bill passed by Congress in December directed the Office of the National Coordinator for Health Information Technology (ONC) to decertify electronic health record products that are knowingly interfering with the sharing of health information.

Decertifying EHR Vendors that Knowingly Interfere with Sharing Patient Data

“ONC should take steps to decertify products that proactively block the sharing of information because those practices frustrate the congressional intent, devalue taxpayer investments in [Certified EHR Technology], and make [EHR] technology less valuable and more burdensome for eligible hospitals and eligible providers to use,” the bill states.

The legislation also instructed ONC to submit a report to Congress outlining the extent of the information-sharing issues, which may be intentional or caused by technological glitches. That 39-page report was released in April. It shows that ONC is grappling to determine the depth of the problem of data blocking and to find ways to respond.

Data Blocking Increases Healthcare Costs: ONC Establishes Reporting Path

The agency said it received about 60 unsolicited reports of information blocking in 2014. Included were vendors who charge “comparatively high prices to establish certain common types of interfaces—such as connections to local labs and hospitals.” Other issues involved vendors who make it cost-prohibitive for most customers to send, receive or export health data within EHRs.

Karen DeSalvo, M.D., the National Coordinator for Health Information Technology, acknowledged in a Modern Healthcare article that ONC does not “have a lot of quantified information right now.”

Karen DeSalvo, M.D.

Karen DeSalvo, M.D., National Coordinator for Health Information Technology at the Department of Health and Human Services, admits more needs to be done to end data blocking practices. “Information blocking is certainly not the only impediment to an interoperable learning health system. But based on the findings in our report, it is a serious problem—and one that is not being effectively addressed.” (Photo copyright the United States Department of Health and Human Services.)

In an effort to learn more about data blocking issues, the Centers for Medicare and Medicaid Services (CMS) has created a new e-mail address at noinformationblocking@cms.hhs.gov. It is asking patients, pathologists, and other healthcare providers to report their personal experiences with data blocking.

“We would like to hear about every example—small, medium, large—when someone is getting in the way of interoperability,” acting CMS Administrator Andy Slavitt told Modern Healthcare. “We want as a team to hear about these examples and confront them.”

ONC Determined to Prevent Data Blocking

The ONC has acknowledged that many of the data-blocking practices “are beyond the reach of current federal laws and programs to address.”

“A comprehensive approach will require overcoming significant gaps in current knowledge, programs, and authorities that limit the ability of ONC and other federal agencies to effectively target, deter, and remedy this conduct, even though it frustrates the important public policy of enabling electronic health information to flow in support of patients and improvements in health and health care,” the report said.

Andy Slavitt

Andy Slavitt, Acting Administrator for the Centers for Medicare & Medicaid Services, is asking healthcare providers and patients to report instances of data blocking via a new e-mail address at noinformationblocking@cms.hhs.gov. “We would like to hear about every example—small, medium, large—when someone is getting in the way of interoperability. We want as a team to hear about these examples and confront them.” (Photo copyright the Centers for Medicare & Medicaid Services.)

While ONC searches for a comprehensive solution to the information-sharing problem, the report suggests taking these steps:

• Proposing new certification requirements that strengthen surveillance of certified health IT capabilities “in the field.”

• Proposing new transparency obligations for certified health IT developers that require disclosure of restrictions, limitations, and additional types of costs associated with certified health IT capabilities.

• Specifying a nationwide governance framework for health information exchange that establishes clear principles about business, technical, and organizational practices related to interoperability and information sharing.

• Working with CMS to coordinate healthcare payment incentives and leverage other market drivers to reward interoperability and exchange and discourage information blocking.

• Helping federal and state law enforcement agencies identify and effectively investigate information blocking in cases where such conduct may violate existing federal or state laws.

• Working in concert with the HHS Office for Civil Rights to improve stakeholder understanding of the HIPAA Privacy and Security standards related to information sharing.

Some health IT vendors continue to push back against efforts to end data blocking, arguing they must protect proprietary technology and information, but the ONC remains steadfast in its demand for the open transfer of information.

“We’re going to be calling on the private sector to commit to [openness] with us in a more public fashion—to say that [blocking is] not OK,” DeSalvo, who also serves as Acting Assistant Secretary for Health in the Department of Health and Human Services, told Modern Healthcare.

EHR Vendors Pledge Cooperation

Perhaps because of the fear of federal government intervention, several EHR vendors recently agreed to stop charging fees for interfaces and pledged to work toward interoperability. Epic Systems announced at this year’s HIMSS conference that it would no longer charge customers for data transfers between Epic customers and non-Epic customers through a module formerly called Care Everywhere.

“We’re not going to charge for Care Everywhere for at least until 2020,” Epic CEO Judy Faulkner told Modern Healthcare. Epic’s health information exchange fees range as high as 20 cents per record and an annual $2.35-per-person charge for receiving messages from non-Epic systems, Modern Healthcare reported.

Epic’s announcement followed AthenaHealth’s decision to absorb all information exchange costs made through CommonWell Health Alliance, a vendor-led alliance that formed in 2013 to create an interoperability platform. Founding members include:

Allscripts,

Athenahealth,

Cerner,

CPSI (now Evident),

Greenway,

McKesson, and,

Sunquest.

Cooperation Still a Challenge

Getting companies with competing products or patient pools within the healthcare industry to embrace openness and interoperability continues to be a challenge. Craig Brammer, CEO, of the Health Collaborative in Cincinnati, which has persuaded the major health systems in the region to collaborate and share data to improve health outcomes, told Modern Healthcare that the competitive nature of the healthcare industry is a barrier to openness.

“If you’re a hospital CEO in the past, you didn’t think about how am I going to make it easier for my customers to go to my competitor,” he said. “It makes perfect economic sense to be where we are today.”

When delivering the “Report to Congress on Health Information Blocking,” DeSalvo and Jodi Daniel, J.D., Director, Office of Policy, acknowledged that hurdles remain to achieving an “interoperable learning health system.”

“Information blocking is certainly not the only impediment to an interoperable learning health system. But based on the findings in our report, it is a serious problem—and one that is not being effectively addressed,” they wrote on the ONC’s HealthIT.gov website.

Clinical Labs and Pathology Groups Would Like to See an End to Data Blocking

Until federal officials take effective action, data blocking will continue to be an issue for clinical laboratories and anatomic pathology groups, since they are regularly asked to bear the cost of creating an interface between their laboratory information systems and the EHR systems of their client physicians. Resolution of the data-blocking problem will be a welcome development across the medical laboratory testing industry.

—Andrea Downing Peck

Related Information:

ONC Targets ‘Information-Blocking’ But Has Few Weapons for the Fight

Report to Congress on Information Blocking

ONC Fail: EHR ‘Data Blocking’ Still Rampant

Epic, Other EHR Vendors Agree to Waive Record-Sharing Fees

Are You a Victim of Data Blocking? The Obama Administration Wants to Know

Congress Directs ONC to Decertify EHRs Blocking Information Sharing

EHR Data ‘Blocking’ Hobbles HIT Says ONC

ONC Targets ‘Information-Blocking’ But Has Few Weapons for the Fight

Health-Information-Blocking Undermines Health System Interoperability and Delivery Reform

CVS MinuteClinic to Use Epic EMR in Support of Nationwide Growth Plan, also Opens Possibility of Accessing Clinical Laboratory Data from Local Providers

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