HealthBlawg

David Harlow's Health Care Law Blog

    • Twitter
    • Facebook
    • LinkedIn
    • RSS
    • Email
  • About
  • Archives
  • Podcast
  • Press
  • Awards/Reviews
  • HIPAA
  • HCSM

Locked Down or Blocked Up? ONC Report on Health Information Blocking

May 6, 2015

The good people in Congress recently asked ONC: When it comes to the nationwide roll-out of a connected health IT system, are we getting our 28 billion dollars’ worth?

Since one of the advantages of health IT is the potential for creating interoperable systems and the means of delivering data to patients, providers and payors when and where they need it, in order to provide better, more cost-effective care, it seems like a fair question. The more pointed question from the Hill was: How many actors in the health data ecosystem are blocking data, and what should we do about it?

ONC’s report on health information blocking broke down the root causes behind the lack of clear and easy communication into two buckets.

The first is the collection of generally non-malevolent lack of coordination of technical or practical standards that are “beyond the control of any individual actor” and represent what ONC called “systemic barriers to interoperability that the HITECH Act and other reforms directly seek to address.” Per ONC, the Ten Year Plan (aka the interoperability roadmap) describes what needs to happen to set these things straight. (If I were on the receiving end of this report, I might ask, Aren’t we already six years and $28 billion into this? Why don’t we have results yet?)

The second includes information blocking, “where persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information.” Some choice examples of information blocking (well, categories, really, no naming names in this report), when undertaken knowingly and without reasonable justification:

  • Contract terms, policies, or other business or organizational practices that restrict individuals’ access to their electronic health information or restrict the exchange or use of that information for treatment and other permitted purposes.
  • Charging prices or fees (such as for data exchange, portability, and interfaces) that make exchanging and using electronic health information cost prohibitive.
  • Developing or implementing health IT in non-standard ways that are likely to substantially increase the costs, complexity, or burden of sharing electronic health information, especially when relevant interoperability standards have been adopted by the Secretary.
  • Developing or implementing health IT in ways that are likely to β€œlock in” users or electronic health information; lead to fraud, waste, or abuse;or impede innovations and advancements in health information exchange and health IT-enabled care delivery.

How will ONC deal with this issue? Well, six years in, the report calls for addressing gaps in current knowledge, programs and authorities. Specifically:

  • Limited evidence and knowledge of information blocking.
  • Limitations of certification for addressing information blocking by developers.
  • Limitations of program oversight for addressing information blocking by providers.
  • Inadequate legal protections and enforcement mechanisms for information blocking.
  • Lack of transparency and information about health IT products and services.
  • Need for an effective governance mechanism for nationwide health information interoperability.

Addressing these gaps would be a noble, laudable undertaking. A day late and a dollar short, as they say, but noble nonetheless. Meanwhile, the ultimate goal of the entire program, interoperability, in service of the Triple Aim, remains at risk.

If I were Congress, I might be thinking about asking for my money back.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

Photo credit: Flickr CC Holly Victoria Norval

Filed Under: EHR, Health care policy, Health Law, HIT, ONC

you might also like:

  1. Health Information Exchange: Meaningful Consent

  2. Electronic Exchange of Lab Results: A social-media-prompted response to the ONC RFI on interoperability

  3. ONC releases RFI on catalyzing interoperability of EHRs at HIMSS13

« Privacy and Security Guide released by ONC
An avalanche of unnecessary medical care »

Comments

  1. Dan Munro says

    May 6, 2015 at 11:45 am

    Congress may (ask for their money back), but there won’t be any refunds – and I don’t think they were naive or stupid in understanding this risk long before asking ONC for “evidence” (which ONC also avoided giving them).

    Congress could have easily mandated interop as a function of MU1. They can just as easily assess penalties for failure to interop. The question is – will they. Given the history (and lobbying) I think this dance is endless.

    • David Harlow says

      May 6, 2015 at 1:21 pm

      Well, Congress can’t easily do much of anything these days…. I agree that the dance is potentially endless, though. For me, the question is whether taking it to the next level (i.e., lower-case meaningful use of health IT) will be a public sector or private sector initiative. All indications seem to be pointing to the private sector. The most productive thing for Congress to do at this point might be to butt out and move along. The enormous cash infusion under the Recovery Act was perhaps not directed with as much precision as one might have hoped, but the fact of the matter is that many more providers are wired (or wireless) than were before. The legal infrastructure for requiring folks to share information appropriately with patients is already present, and sharing with other providers (as well as with patients) now becomes driven more by market forces.

  2. Sue Ann Jantz says

    May 7, 2015 at 10:24 am

    Actually, having used e-medical records for 11 years now, silo of data was prevalent and intentional. It’s taken $28 billion to highlight it as a PROBLEM, not just “what happens.” Interoperability also has to be pushed by those of us in the trenches, the foot soldiers of HIT, and I run into very many who are older and don’t trust computers — they trust paper where they can see it. The other side of the spectrum is young invincibles who believe ONLY technology is worthwhile.
    In short, a cohesive journey forward needs to blend these two groups, so that older can hand off to younger. Otherwise, the eggs (patients) being juggled smash on the ground — we saw that with Ebola in Texas. I’m surprised it doesn’t happen more often.

Trackbacks

  1. Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR » Top 10 Recent Quotes on Healthcare Interoperability says:
    July 29, 2015 at 8:44 am

    […] The good people in Congress recently asked ONC: When it comes to the nationwide roll-out of a connec… […]

Follow me on Twitter

David Harlow πŸ’‰πŸ˜· Follow 42,910 17,570

Mastodon @healthblawg@c.im #HealthCare #MedDevice #Compliance #Privacy @MyOmnipod #HIPAA #digitalhealth #HarlowOnHC #pinksocks Tweets are tweets No more no less

healthblawg
healthblawg avatar; David Harlow πŸ’‰πŸ˜· @healthblawg ·
5h 1620535759902998528

The Harlow #Healthcare #Innovation Daily #digitalhealth #hcldr #HarlowOnHC #digitalhealth #healthtech

Image for twitter card

Google Research and DeepMind develop AI medical chatbot

digitalhealth.net A new AI-powered medical-specific chatbot developed by Google and DeepMind has shown some potential for clinical applications.

paper.li

Reply on Twitter 1620535759902998528 Retweet on Twitter 1620535759902998528 0 Like on Twitter 1620535759902998528 0 Twitter 1620535759902998528
healthblawg avatar; David Harlow πŸ’‰πŸ˜· @healthblawg ·
6h 1620524933863378944

ICYMI> Paul Schrimpf, at Prophet Consulting, Driving Health Care Transformation β€” Harlow on Healthcare https://healthblawg.com/2022/12/paul-schrimpf-prophet-consulting.html?utm_source=twitter&utm_medium=social&utm_campaign=ReviveOldPost #digitalhealth #hcldr #hitsm

Image for the Tweet beginning: ICYMI>  Paul Schrimpf, at Twitter feed image.
Reply on Twitter 1620524933863378944 Retweet on Twitter 1620524933863378944 0 Like on Twitter 1620524933863378944 0 Twitter 1620524933863378944
healthblawg avatar; David Harlow πŸ’‰πŸ˜· @healthblawg ·
11h 1620445622955278337

Moonshots β€” StartUp Health https://paper.li/healthblawg/1369855999?read=https%3A%2F%2Fwww.startuphealth.com%2Fmoonshots #hcldr

Reply on Twitter 1620445622955278337 Retweet on Twitter 1620445622955278337 0 Like on Twitter 1620445622955278337 0 Twitter 1620445622955278337
Load More
Follow me on Mastodon

HIPAAtools

Hipaatools

The HIPAA Compliance Toolkit

The Walking Gallery

The Walking Gallery

Quick Links

  • Home
  • Categories
  • Archives
  • Podcast Interviews
  • HIPAAtools
  • HIPAA Compliance
  • Health Care Social Media
  • Speaking
  • In the Press
  • Blogroll

David Harlow

David Harlow

HealthcareNOW Radio

Connect with David

  • Twitter
  • Facebook
  • LinkedIn
  • RSS
  • Email
  • Subscribe
  • Contact
  • Book Me: Speaking
  • About
  • The Harlow Group LLC
Copyright © 2006–2023
HealthBlawg is a publication of The Harlow Group LLC. See Copyright notice and disclaimer.
Fair use with attribution and a link is encouraged. Click for more on David Harlow.
[footer_backtotop text="Back to top" href="#"]