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Healthcare providers are hiding behind HIPAA regulations and are hindering interoperability, with many actively involved in information blocking according to a recent ONC report to congress.
On Friday, ahead of HIMSS 2015, the Office of the National Coordinator for Health IT’ issued a report to congress as required under the 2015 Omnibus Appropriations bill.
The report sheds light on the practice of “Information Blocking” in the healthcare industry and suggests that the problem is beyond the scope of current agencies to “detect, investigate and address the problem”. Only last summer Epic Systems was criticized for poor interoperability with EHRs, with Rep. Phil Gingrey (R-Ga) particularly vocal on the matter.
The problem is understood to be widespread, and it is not only vendors who are responsible, although many are hampering interoperability efforts by restricting information flow and creating closed systems. The healthcare industry is also at fault according to the report. It states that “A common charge is that some hospitals or health systems engage in information blocking to control referrals and enhance their market dominance.”
There are numerous reasons why this is the case, and the Health Insurance Portability and Accountability Act (HIPAA) has been cited as one of the problems. According to the report, the ONC says that it has received reports “that privacy and security laws are cited in circumstances in which they do not in fact impose restrictions,”
The report gives a common example, where a healthcare provider hides behind the Privacy Rule and refuses to share information when in actual fact; the Privacy Rule does actually permit the sharing of data under the circumstances.
The Office for Civil Rights may be charged with policing HIPAA, but with the budgetary restraints and a severe lack of resources – it is struggling to implement the second round of compliance audits – it cannot be expected to offer much ore assistance in removing barriers.
The ONC does offer some solutions and suggests a set of new standards that federal agencies – including the ONC – need to adopt to begin to tackle what appears to be a very real problem within the healthcare industry. Without action it threatens to undermine to development of a fully interoperable learning health system.
Addressing Gaps in Current Knowledge
There is only limited evidence of the extent to which information blocking is a problem. The ONCs proposed actions include attempting to fill knowledge gaps. Evidence of the practice must be uncovered and the ONC wants a “Lack of transparency and information about health IT products and services” and calls for “an effective governance mechanism for nationwide health information interoperability. The report states that there are inadequate legal protections and enforcement mechanisms for information blocking. These are all areas that it hopes to address.
Its targeted actions are listed as:
- Strengthen in-the-field surveillance of health IT certified by ONC.
- Constrain standards and implementation specifications for certified health IT.
- Promote greater transparency in certified health IT products and services.
- Establish governance rules that deter information blocking.
- Work in concert with the HHS Office for Civil Rights to improve stakeholder understanding of the HIPAA Standards related to information sharing.
- Coordinate with the HHS Office of Inspector General and the Centers for Medicare and Medicaid Services concerning information blocking in the context of the federal Anti-Kickback Statute and Physician Self-referral Law.
- Refer illegal business practices to appropriate law enforcement agencies.
- Work with CMS to coordinate health care payment incentives and leverage other market drivers to reward Interoperability and exchange and discourage information blocking.
- Promote competition and innovation in health IT and healthcare
The full ONC report can be obtained here: April 2015: ONC Information Blocking Report