[{"innerBlocks":[],"name":"core\/freeform","postId":126429,"blockType":{"name":"core\/freeform","keywords":[],"attributes":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"providesContext":[],"usesContext":[],"selectors":[],"supports":{"className":false,"customClassName":false,"reusable":false},"styles":[],"variations":[],"apiVersion":3,"title":"Classic","description":"Use the classic WordPress editor.","category":"text"},"originalContent":"A recent University of Michigan survey asked health information exchange (HIE) professionals about their experience with information blocking. Respondents clearly indicated that information blocking is real and is practiced by both health systems and EHR vendors.

\u201cHalf of respondents reported that EHR vendors routinely engage in information blocking, and 25 percent of respondents reported that hospitals and health systems routinely do so,\u201d write professors Adler-Milstein and Pfeifer in their report. \u201cAmong EHR vendors, the most common form of information blocking was deploying products with limited interoperability. Among hospitals and health systems, the most common form was coercing providers to adopt particular EHR or HIE technology.\u201d

The survey results are especially incriminating for EHR vendors\u2014researchers contend that they either \u201croutinely\u201d or \u201coccasionally\u201d engage in information blocking, according to 88 percent of respondents. Hospitals and health systems fared better, but 59 percent of survey participants still used \u201croutinely\u201d and \u201coccasionally\u201d to describe information blocking behavior.

The survey gets more interesting as it delves into specific tactics. Respondents said information blocking among EHR vendors usually takes these eight forms and occurs with a corresponding frequency shown in parentheses.

Products have limited interoperability (49 percent)<\/li>
High HIE fees unrelated to cost (47 percent)<\/li>
Third-party access to data is difficult (42 percent)<\/li>
Refuse to support particular HIEs (31 percent)<\/li>
Data export is difficult (28 percent)<\/li>
HIE contract terms change after implementation (19 percent)<\/li>
Unfavorable HIE contract terms (17 percent)<\/li>
Gag clauses on speaking about info blocking (12 percent)<\/li><\/ul>
Hospitals and health systems, the survey showed, try to block information by pressuring providers to adopt specific technology (28 percent), controlling patient flow through selective data sharing (22 percent) and using HIPAA as an excuse to not share patient data (15 percent).

When survey respondents were asked why they thought these impediments to interoperability still exist, they mostly said they believe that EHR vendor goals are to maximize short-term profit and increase the likelihood their products will be selected.

Of course, as has been pointed out many times and in various forums, healthcare is not just like any other marketplace. In truth, EHR vendors are caretakers of information that nurtures a public good. The measures of success in this arena are both patient health and sales totals.

The Michigan study survey results are supported by the anecdotal experience of individual physicians like Peter Masucci. \u201cI went digital 11 years ago and embraced an electronic health record,\u201d writes Masucci in a recent article on STAT. \u201cWhile things aren\u2019t perfect, they\u2019re very good. Yet now I\u2019m being told by the managers of my affiliated group that I and all of the other physicians in the affiliated group must adopt and use the same new electronic health record platform.

\u201cThat doesn\u2019t make sense to me. I have an iPhone and my neighbor has an Android, but we can still communicate. My bank account is with TD Bank and I regularly get my money from Citizens Bank ATMs; communication seems to be working there. Why in 2017 must all doctors be on the same system to communicate and share information?\u201d

Even though the technology to readily enable interoperability is not there yet, interfaces can still be built and all HIEs can be supported\u2014there is simply is no legitimate healthcare-oriented reason for such EHR limitations on practitioners.

\u201cWhat has been substantially underappreciated, however, is the fact that, for the key actors needed to enable HIE to occur\u2014provider organizations and vendors\u2014there might be more benefit, or at least more certain benefit, from not [participating in HIEs],\u201d writes Julia Adler-Milstein in Health Affairs. \u201cAnd as a result, these actors may behave in ways that interfere with the free flow of patient information that is needed to improve health and healthcare.\u201d

The solution, according to the Michigan study, is a change of incentives. While the federal incentives for EHR adoption are obviously reimbursement, the incentives that enable the free flow of patient information between systems and doctors remains elusive.

How might those incentives change? One obvious approach is government regulation, which is mentioned in last year\u2019s 21st Century Cures Act, but more oversight is not what most in healthcare want to see. Since five EHR vendors control roughly 70 percent of the EHR market, a better approach might be to willingly embrace HIE and the policies\/technologies necessary to make it happen.

Is that asking too much of for-profit businesses? It might be. But as with most issues in healthcare, what is not effectively managed to benefit patients eventually becomes something potentially regulated by Congress. The question now might be who will blink first\u2014the information blockers or Congress?","saveContent":"A recent University of Michigan survey asked health information exchange (HIE) professionals about their experience with information blocking. Respondents clearly indicated that information blocking is real and is practiced by both health systems and EHR vendors.

\u201cHalf of respondents reported that EHR vendors routinely engage in information blocking, and 25 percent of respondents reported that hospitals and health systems routinely do so,\u201d write professors Adler-Milstein and Pfeifer in their report. \u201cAmong EHR vendors, the most common form of information blocking was deploying products with limited interoperability. Among hospitals and health systems, the most common form was coercing providers to adopt particular EHR or HIE technology.\u201d

The survey results are especially incriminating for EHR vendors\u2014researchers contend that they either \u201croutinely\u201d or \u201coccasionally\u201d engage in information blocking, according to 88 percent of respondents. Hospitals and health systems fared better, but 59 percent of survey participants still used \u201croutinely\u201d and \u201coccasionally\u201d to describe information blocking behavior.

The survey gets more interesting as it delves into specific tactics. Respondents said information blocking among EHR vendors usually takes these eight forms and occurs with a corresponding frequency shown in parentheses.
- Products have limited interoperability (49 percent)<\/li>
- High HIE fees unrelated to cost (47 percent)<\/li>
- Third-party access to data is difficult (42 percent)<\/li>
- Refuse to support particular HIEs (31 percent)<\/li>
- Data export is difficult (28 percent)<\/li>
- HIE contract terms change after implementation (19 percent)<\/li>
- Unfavorable HIE contract terms (17 percent)<\/li>
- Gag clauses on speaking about info blocking (12 percent)<\/li><\/ul>
  Hospitals and health systems, the survey showed, try to block information by pressuring providers to adopt specific technology (28 percent), controlling patient flow through selective data sharing (22 percent) and using HIPAA as an excuse to not share patient data (15 percent).
  
  When survey respondents were asked why they thought these impediments to interoperability still exist, they mostly said they believe that EHR vendor goals are to maximize short-term profit and increase the likelihood their products will be selected.
  
  Of course, as has been pointed out many times and in various forums, healthcare is not just like any other marketplace. In truth, EHR vendors are caretakers of information that nurtures a public good. The measures of success in this arena are both patient health and sales totals.
  
  The Michigan study survey results are supported by the anecdotal experience of individual physicians like Peter Masucci. \u201cI went digital 11 years ago and embraced an electronic health record,\u201d writes Masucci in a recent article on STAT. \u201cWhile things aren\u2019t perfect, they\u2019re very good. Yet now I\u2019m being told by the managers of my affiliated group that I and all of the other physicians in the affiliated group must adopt and use the same new electronic health record platform.
  
  \u201cThat doesn\u2019t make sense to me. I have an iPhone and my neighbor has an Android, but we can still communicate. My bank account is with TD Bank and I regularly get my money from Citizens Bank ATMs; communication seems to be working there. Why in 2017 must all doctors be on the same system to communicate and share information?\u201d
  
  Even though the technology to readily enable interoperability is not there yet, interfaces can still be built and all HIEs can be supported\u2014there is simply is no legitimate healthcare-oriented reason for such EHR limitations on practitioners.
  
  \u201cWhat has been substantially underappreciated, however, is the fact that, for the key actors needed to enable HIE to occur\u2014provider organizations and vendors\u2014there might be more benefit, or at least more certain benefit, from not [participating in HIEs],\u201d writes Julia Adler-Milstein in Health Affairs. \u201cAnd as a result, these actors may behave in ways that interfere with the free flow of patient information that is needed to improve health and healthcare.\u201d
  
  The solution, according to the Michigan study, is a change of incentives. While the federal incentives for EHR adoption are obviously reimbursement, the incentives that enable the free flow of patient information between systems and doctors remains elusive.
  
  How might those incentives change? One obvious approach is government regulation, which is mentioned in last year\u2019s 21st Century Cures Act, but more oversight is not what most in healthcare want to see. Since five EHR vendors control roughly 70 percent of the EHR market, a better approach might be to willingly embrace HIE and the policies\/technologies necessary to make it happen.
  
  Is that asking too much of for-profit businesses? It might be. But as with most issues in healthcare, what is not effectively managed to benefit patients eventually becomes something potentially regulated by Congress. The question now might be who will blink first\u2014the information blockers or Congress?","order":0,"get_parent":{},"attributes":[],"attributesType":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"dynamicContent":""}]

Why healthcare information still doesn’t flow freely

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