How Information Blocking Hurts Health Systems and How to Fix It

Author: Smile CDR

Information blocking can happen when electronic health information isn’t shared or when sharing is purposely discouraged by a health system, health information network (HIE) or electronic health record (EHR) vendor. It may involve a patient's health information or other types of data and often negatively impacts the health system by raising costs and reducing the timeliness and quality of care patients receive. Ultimately, it can lead to worse health outcomes for patients.

Given what’s at stake, information blocking has become a hot topic, and the majority of providers want to minimize or eliminate information blocking. Unfortunately, too often, the digital transformation and associated upfront pain required to fix information blocking often exceed that of maintaining the “status quo,” at least in the near term. 

That’s changed with a new slate of regulations that heavily penalizes information blocking. Compliance with these regulations has become one of the main drivers for health organizations to eliminate these practices. Beyond avoiding legal penalties, providers who take steps to ensure free yet secure flows of information can achieve better patient care, improved stakeholder communication, and high patient and clinician satisfaction.

How common is information blocking? 

Information blocking is most common among EHR vendors, but it can affect many parts of the healthcare system. A study published in the Journal of the American Medical Informatics Association (JAMIA) found that 55% of EHR vendors and 30% of health systems engage in some form of information blocking. 

The JAMIA study also showed that the most common behaviour for EHRs was to set unreasonably high prices to block information sharing, which 42% of the vendors engaged in. On the other hand, the most common behaviour for health systems was to simply refuse to share information, which occurred among 14% of health systems. 

Regional competition among EHR vendors also has an impact on information blocking. In specific geographic areas that have higher competition among EHRs, blocking is more common. Although providers can't control EHR vendor behaviour, it’s helpful to understand why it happens when you’re working on eliminating data blocking in your health system.  

Government regulations about information blocking 

As the push for digital transformation in healthcare becomes stronger, we’re seeing more regulatory efforts. For example, the 21st Century Cures Act (Cures Act) wants to improve information exchange in healthcare in the United States by eliminating blocking. 

In 2020, the Office of the National Coordinator for Health Information Technology (ONC), which is part of the Department of Health and Human Services (HHS), issued a final interoperability rule for the Cures Act. The final rule states that health systems, EHR vendors, and health IT developers can be held accountable for blocking data. 

The final rule lists eight exceptions that don't count as information blocking, including security, preventing harm, privacy, infeasibility, health IT performance, content and manner, fees, and licensing. In general, the Cures Act allows information blocking to protect a patient’s safety or privacy. However, the Cures Act strongly discourages blocking in other cases. 

The HHS can issue a penalty of up to $1 million per information blocking violation to health IT developers. Although the HHS is still in the process of creating other enforcement penalties, they have already created a process where anyone can submit a complaint about information blocking through the Information Blocking Portal. It’s also possible to send an anonymous report, which can often encourage more people to come forward and report bad actors. 

The U.S. government is not the only organization trying to encourage better information sharing. The American Medical Association (AMA) also supports the end of data blocking. The AMA wants better health information interoperability to make it easier for physicians, patients, and other members of the healthcare system to share data—which provides the foundation for the long sought after digital transformation needed for interoperability. 

What the public thinks of information blocking

Americans also strongly oppose information blocking practices and support better health data sharing between their providers, health systems, and EHRs. A Pew survey found that Americans want the government to make it easier to share and access their health information. 

The survey also showed that 81% of adults want their healthcare providers to be able to share patient health record information between their EHR systems, and 53% of surveyed adults want to be able to download their medical records. In addition, 87% want electronic access to CT scans, X-rays, and other images in their EHR.

In general, the public doesn't want information blocking to happen in their health systems or EHRs. They want the same convenience they’ve become accustomed to with online banking and shopping. They want the “Internet of Health”.

How health systems can fix information blocking 

The first step providers should take towards eliminating information blocking is to evaluate their current processes to ensure they are compliant with the Cures Act. A thorough evaluation of all of internal compliance programs can help identify the cause, and sources, of any information blocking.

Providers should also deploy a Fast Healthcare Interoperability Resources (FHIR) server for data sharing and extended EHR functionality. A FHIR server is able to process, validate, and store healthcare data while complying with privacy laws. Instead of storing data in documents, like the Consolidated Clinical Document Architecture (C-CDA) standard, FHIR stores information in “resources”, discrete data elements that are disassociated from their original context. All the resources are “free agents”, stored independently in the FHIR repository and linked together via references. This maintains the benefits of a documents-based approach (context) while allowing the flexibility to extend the data to new forms of exchange—supporting future innovation. 

This opens up a myriad of possibilities for new services, analytics, and data sharing patterns to occur against a common, standards-based backend without the need for additional translation to and from proprietary data models. 

This approach reduces the reliance on the EHR to be all things to all users. A standards-based data repository for all your SMART on FHIR apps can significantly reduce time to deployment and associated costs of deploying new apps or deprecating old ones. By leaning into interoperable data standards through the deployment of a FHIR server, providers can help power data sharing while reducing the total cost of ownership for existing (and future) digital services. 

Looking ahead 

It’s possible to eliminate information blocking and improve data flow in your system. The 21st Century Cures Act can be viewed as a positive step toward removing data blocking in healthcare—to the benefit of everyone who delivers or consumes healthcare services and products. Patients want to see the end of information blocking. They want their data shared securely and easily among themselves, physicians, EHRs, and their health plans. 

As providers improve information flow, they may realize that an EHR isn’t enough to meet all their data sharing needs. Over-reliance on a monolithic EHR can slow down data sharing efforts, lower customer satisfaction, and expose organizations to potential data blocking penalties. It can also stop digital transformation efforts that are needed for initiatives like remote care, patient engagement, and more. 

By adopting SMART on FHIR, organizations can more rapidly reduce information blocking as SMART on FHIR supports seamless app and EHR integration (as well as integration with other systems) while protecting patient data and allowing easier access and retrieval. To power digital transformation, providers must find solutions that make data sharing faster and easier without sacrificing security.