Most information blocking in healthcare is "beyond the current reach" of federal agencies to detect, investigate and address, according to the Office of the National Coordinator for Health IT's report to Congress published Friday.
The report, mandated by Congress last December upon passage of the 2015 omnibus appropriations bill, reveals that efforts to stymie information blocking have been ineffective to date. Rep. Phil Gingrey (R-Ga.), last summer, blasted the lack of EHR interoperability in a congressional hearing, specifically calling out Verona, Wisconsin-based Epic Systems as a creator of closed platforms.
"It may be time for this committee to take a closer look at the practices of vendor companies in this space, given the possibility that fraud may be perpetuated against the American taxpayer," Gingrey said at the hearing.
But the problem of information blocking extends both to EHR developers and healthcare providers, according to the report.
"A common charge is that some hospitals or health systems engage in information blocking to control referrals and enhance their market dominance," the report says.
Providers cite various reasons, according to ONC, including HIPAA provisions.
"It has been reported to ONC that privacy and security laws are cited in circumstances in which they do not in fact impose restrictions," the report says.
National Coordinator for Health IT Karen DeSalvo and Jodi Daniel, ONC's director of policy and planning, charge that such practices "devalue taxpayer investments in health IT," in a Health IT Buzz blog post on the report. They say the "full extent" of the issue is hard to determine due to factors that include contractual restrictions that prevent providers "from reporting or even discussing costs."
"Information blocking is certainly not the only impediment to an interoperable learning health system," DeSalvo and Daniel write. "But based on the findings in our report, it is a serious problem--and one that is not being effectively addressed."
Daniel, on a phone call with reporters shortly after the report's release, said that ONC's efforts to investigate information blocking predated the Congressional request.
"It was perfect timing and an opportunity for us to put something out that summarized the information that we had," Daniel said.
To that end, DeSalvo and Daniel wrote, ONC must continue to work with Congress, the industry and the health IT community at large to tackle the issue.
"We look forward to an ongoing dialogue about this," DeSalvo said on the press call. "It is a priority for us as an administration."
The report outlines several steps ONC and other federal agencies should take, including:
- Strengthen in-the-field surveillance of ONC certified health IT tools, which was proposed in the certification requirements accompanying the Stage 3 Meaningful Use rule
- Constrain standards and implementation specifications
- Promote better transparency in certified health IT products and services that would "make developers more responsive to customer demands and help ameliorate market distortions" that lead to vendor information blocking
- Establish governance rules deterring information blocking, which the report notes is addressed in ONC's interoperability roadmap
- Work with the U.S. Department of Health and Human Services Office for Civil Rights to ensure healthcare stakeholders understand HIPAA privacy and security standards, particularly those related to information sharing
- Coordinate with the HHS Office of Inspector General and the Centers for Medicare & Medicaid Services on information blocking as it relates to physician self-referral and the federal anti-kickback statute
- Refer illegal business practices to law enforcement agencies
- Work with CMS to provide incentives for interoperability while simultaneously discouraging information blocking
- Promote competition and innovation in health IT, which the Federal Trade Commission recommended in its comments on the interoperability roadmap
"While important, these actions alone will not provide a complete solution to the information blocking problem," the report's authors say. "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 violates public policy and frustrates congressional intent."