Information Blocking: A New Term And Promise of a New Era In Electronic Health Information Sharing | At the intersection of health, health care, and policy.
ONC-HIT Interoperability “Imminent Domain”?!?
This is a great summary article that calls attention to the ONC-IT shot off the EMR bow(s). It start with a quote from Report on Health Information Blocking from ONC-HIT to Congress dated April 2015.
“[…] some business practices, though they may arguably advance legitimate individual economic interests, interfere with the exchange of electronic health information in ways that raise serious information blocking concerns. At some point, ONC believes that decisions to engage in such practices are unreasonable as against public policy […]”
This article points out that the ONC-HIT statements seem to put vendors on notice that business policies that get in the way of the ONC interoperability roadmap plans will not be tolerated. This is the cyber equivalent of the Federal “Imminent Domain” of the Monroe doctrine, Lincoln’s railroad imminent domain, and the imminent domain of the 1950s required to complete the US highway system under Eisenhower. My high school history teachers pointed out that Federal “Imminent Domain” is a pre-requisite for overcoming business conflicts of interest and local geographic business interests that could derail (pun intended) a national initiative such as the Lincoln transcontinental railway project.
The ONC-HIT report define “information blocking” as containing the following three components:
- Interference. There must be “an act or course of conduct that interferes with the ability of authorized persons or entities to access, exchange, or use electronic health information.”
- Knowledge. “The decision to engage in information blocking [must be] made knowingly.”
- No Reasonable Justification. Conduct must be “objectively unreasonable in light of public policy.”
These are fighting words but unfortunately the simple words “[must be] made knowingly” and “objectively unreasonable”remind me of the burden of proof of Tobacco company “Knowing” that tobacco caused cancer. The legal debates went on for decades until memos and communications surfaced that demonstrated that the large tobacco companies had put business interests above the health of their clients.
The ONC-HIT suggests 4 potential actions (regulatory sticks) to replace the monetary carrots that created the EMR “too big to control” giants:
- Threaten to decertify EMR systems that are proven to engage in “information blocking”.
- Increase transparency about vendor behavior.
- Establish a a set of governance “rules of the road”.
- Clarifying HIPAA and other health information privacy laws will help remove the potential that exists today for provider organizations and vendors to use these laws as a cover to engage in information blocking.
While these Federal “sticks” may be successful in raising public awareness and appeasing Congress, history would suggest that similar to the Lincoln transcontinental railway project: it will be slow, expensive and may produce a nation of metaphorical displaced Indians and near-extinct buffaloes. Unless the Supreme Court rules about whether patients or proprietors own ePHI and whether the ONC-HIT railway has “imminent domain’ over the perceived squatting rights of the electronic medical records (EMR) dynasties that were created as an unintended consequence of the Federal “Meaningful Use” program.
The ONC-HIT interoperability train has left the [cyber train] station, it may be an interesting and very rough ride. We believe the inherent conflict between ONC-HIT interoperability roadmap and the EMR dynasties’ business incentive to block information sharing with inevitably lead to a Supreme Court showdown. In the meantime, we believe that the Accountable Care Organization (ACO) and shared risk initiatives will require “Meaningful Collaboration(TM)” between healthcare providers rather than just Meaningful Use to simply satisfy compliance requirements.
The basic concept of Meaningful Collaboration(TM) between healthcare stakeholders is a vendor neutral collaboration platform where stakeholders can share provider selected content similar to old hospital charts where doctors rounded at all hours and wrote succinct SOAP notes and contributed provider-centric external content. “Here is what you need to know” to render you consultation.
The radiology industry has experienced “information blocking” with each advance in technology as vendors create proprietary layers to improve business distinction and profitability. In an upcoming series of BLOGs I will discuss what we have learned form the past 30 years of Information Blocking in the Radiology Industry.
We hope for a High Speed Rail rather than Transcontinental Cyber-TrainWreck.
Douglas K Smith MD is ABPM Clinical Informatist and ABR certified radiologist, CHCIO, CPHIMS, serial doctorpreneur, inventor and “doctor centric software designer/developer”.