Healthcare administrators are dramatically underestimating the awareness people within their organizations have about recent information blocking rules and the consequences of failing to comply.
Significant education and training effort will be needed to minimize the risks of violating the new prohibitions on information blocking.
The Office of the National Coordinator for Health IT (ONC) Cures Act Final Rule prohibits any practice by healthcare providers, health information exchanges or health IT developers from interfering with the access, exchange or use of electronic health information (EHI). Such practices are defined as information blocking. Providers, administrators and IT staff make decisions daily that could interfere with the free flow of EHI because those actions are in many instances based on the very noncompliant policies that drove the federal government to institute these rules.
Penalties for health IT vendors could be as high as $1 million per violation. For providers, the federal government is leaving it up to future rule-making to determine penalty amounts. No one wants to be the first organization to face sanctions under these new interoperability rules.
Healthcare organizations must work hard to ensure that everyone in their organization understands the rules and has procedures in place to minimize noncompliance. This includes the legal department and senior executives who set the policy down to administrative operations to ensure the processes are in place to be compliant. Unfortunately, from what we’ve recently learned and witnessed, they have a long way to go.
How well does your staff understand information blocking?
Life Image has been involved in the business of healthcare data interoperability for nearly 15 years, with a particular focus on medical imaging data, so we talk regularly with hospital personnel at IT departments and clinical departments such as radiology and oncology.
We wanted to get a better idea of the level of understanding of the ONC rule throughout the healthcare sector and across departments. Therefore, we sent a survey to nearly 4,000 people who serve a wider range—clinical, technology and administrative staff at provider, payer, IT and other healthcare organizations. These are the people who do the day-to-day work of keeping their organizations running as well as set the broader policy guidelines to follow.
According to our survey results, nearly half of them had not made any changes at all to meet the ONC requirements, and 47% of them said they were unfamiliar with the term “information blocking.”
As a result of these assumptions, they also underestimate the potential negative consequences, because 39% didn’t know that there would be financial penalties for noncompliance.
This lack of understanding is widespread. It can be found in both large and small institutions, in large tertiary care centers and in academic medical centers. Some of these are sophisticated organizations that are spending a lot of money to achieve the necessary compliance.
It's not just a matter of ignorance
There are some reasons for this lack of understanding. The term data blocking can seem vague. But a larger part of the problem might come from the fact that organizations have long had information blocking as part of their business models.
There are many standard and accepted processes within healthcare organizations that are now defined as information blocking. A few examples of information blocking:
- Configuring an EHR so that it is harder to send electronic patient referrals and EHI to an unaffiliated provider
- Having procedures that send requested EHI even if the system could provide it immediately
- Making a patient physically go to a specific location to gain access to their own EHI
- Claiming that HIPAA rules prohibit exchanging EHI with unaffiliated providers
Many existing policies and procedures, and thus habits and workflows, are grounded in the view that patient data shouldn’t be shared freely, particularly with potential competitors for a patient’s business. Policies and procedures take some time to change. Habits and workflows take even longer.
We need to make sure this happens
We need to understand that these changes will be significant and shouldn’t underestimate what needs to be accomplished at every level of the organization. Organizations need to invest in significant staff education and training to ensure that the changes stick. Otherwise, they will get resistance from their staff.
This change will benefit everyone in the long run, but in the present moment, as healthcare professionals are just trying to do their jobs, it doesn’t feel like it’s benefiting them. But penalties for noncompliance are real and should be. Organizations need support in making these changes, but also need to know that they will suffer negative consequences if they don’t.
If resistance leads to a lack of enforcement, these rules may suffer a slow death, and a decade or so from now we’ll again be talking about how interoperability and the free flow of clinical information would be great if we could only figure out how to accomplish it.
We’re done with that conversation. We need to make this work.
Matthew Michela is CEO and president of Life Image.