Playing the Information Blocking Blame Game

If there’s one thing healthcare is good at, it’s finger-pointing. It’s always someone else’s fault that costs are too high, quality is too low or access is too limited.

The same is true with the sharing of patient health data. It’s always someone else’s fault that providers don’t share patient health information among and between themselves despite the fact that sharing would lower costs, improve quality and expand access for consumers. Coulda, woulda, shoulda.

The information-blocking provisions of the 21st Century Cures Act were designed to fix that. The rules that implemented the provisions took effect in April 2021. They bar behaviors that prevent or discourage the exchange of electronic health information. You have to share when someone wants to share. You don’t have a choice.

A new study in the Journal of the American Medical Informatics Association, or JAMIA, gives us our first before-and-after pictures of the finger-pointing over the failure to share patient health data — the failure that led to the information-blocking rules.

The study, published by researchers from the U.S. Department of Health and Human Services Office of the National Coordinator for Health Information Technology (ONC), is based on data from an American Hospital Association (AHA) survey of 2,092 hospitals. The AHA conducted the survey from April through September 2021, or the first six months after the rules took effect.

ONC researchers analyzed the survey data to answer to two main questions: Who do hospitals blame for information blocking (they had four choices), and how do the perps block it (hospitals had up to four choices, depending on who they blamed)?

Overall, 42% of the hospital respondents said at least one of four “actors” engaged in information blocking. Of those four actors, hospitals blamed other individual healthcare providers the most:

• 36% blamed other individual healthcare providers.
• 19% blamed state, regional and/or local health information exchanges (HIEs).
• 17% blamed electronic health records (EHR) vendors.
• 7% blamed national provider networks.
• The rest either didn’t answer or said they didn’t know who to blame.

If a hospital blamed an individual healthcare provider, the information-blocking methods, in ranked order, were:

• Artificial technical, process or resource barriers (cited by 35% of the respondents).
• Strategic affiliations (cited by 32% of the respondents).
• Refusal to exchange patient information (cited by 26% of the respondents).

If a hospital blamed an EHR vendor, the information-blocking methods, in ranked order, were:

• Price, including unreasonable fees (cited by 28% of the respondents).
• Contract language to discourage exchange of patient information (cited by 20% of the respondents).
• Artificial technical, process or resource barriers (cited by 19% of the respondents).
• Refusal to exchange patient information (cited by 10% of the respondents).

In short, after the rules took effect, most hospitals pointed the finger at other hospitals.

Who got the finger before the rules took effect? The answer is EHR vendors.

At least that was the outcome of a survey of 89 HIEs that ONC researchers conducted between May 2019 and February 2020, or more than a year before the information-blocking rules took effect. ONC  published their study findings in JAMIA in January 2021.

Here’s what that survey of HIEs found:

• 55% said at least some EHR vendors engaged in information blocking compared with 24% who said the same thing about health systems.
• 14% said most or all of EHR vendors engaged in information blocking compared with 6% who said the same thing about health systems.

So why did the leading information-blocking suspects flip-flop after the new rules took effect?

ONC researchers commented on the flip-flop in its most recent study. They speculated that EHR vendors quickly cleaned up their act to comply with the new rules. Or hospitals were more likely to point the finger at other providers whom they compete with daily and see patient information as proprietary market data.

If I had to guess, I’d pick the latter. It’s provider competition.

Have you ever tried to get your old in-network medical group to send your medical records to your new in-network medical group because you had to switch health insurance plans? I rest my case. That’s who I’m pointing the finger at.

Thanks for reading.