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

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 “lock 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