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.

Source: Information Blocking: A New Term And The Promise Of A New Era In Electronic Health Information Sharing

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:

1. 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.”
2. Knowledge. “The decision to engage in information blocking [must be] made knowingly.”
3. 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:

1. Threaten to decertify EMR systems that are proven to engage in “information blocking”.
2. Increase transparency about vendor behavior.
3. Establish a a set of governance “rules of the road”.
4. 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”. 

Information Blocking by EMR systems threaten to disconnect the ONC interoperability roadmap.

Meaningful Collaboration allows medical providers within different EMR systems to collaborate and share content within a vendor neutral platform using a variety of interoperability methods including: Application Programming Interface (API), HL7 FHIR, and web services connecting applications that may be required to provide supporting features. Meaningful Collaboration(TM) is an physician inspired approach of leveraging technology to foster collaboration between medical stakeholders to enhance care and improve efficiency of healthcare/

Health IT interoperability refers to the unimpeded exchange of healthcare information between data repositories. As a telradiologist licensed in 35 states, ABPM certified clinical informatist, CHIME member, CPHIMS, and Founder of two national teleradiology companies, I have learned some important lessons about healthcare IT interoperability during the past 25 years.

Health IT interoperability is focused on technical conveyance of healthcare information between medical entities but this is a bare minimum technical requirement. In most cases, I have found that the transfer of large data data sets without clinically useful context  is Meaningless Use of electronic health records rather than Meaningful Collaboration(TM)  between medical providers caring for the same patient.

During my 25 years of radiology, I have experienced multiple types of obstacles and challenges to health IT interoperability. Most medical providers report challenges accessing health information that reside within different EMR systems. Several years ago, I was excited to learn about Regional Health Information Organizations (RHIO) as method for information sharing between healthcare stakeholders. Unfortunately most RHIOs failed miserably for a veariety of reasons and were replaced by Health Information Exchanges (HIE). Some HIEs are thriving although most HIEs are struggling for a variety of reasons: political, financial, or low medical provider enrollment.

My experience with a HIE is that data contribution is almost exclusively from large hospital entities with very little contribution form radiology centers or outpatient medical entities. These significant content gaps makes it difficult for our practice to rely on the HIE for a full picture of a patient;s health information. In addition, medical entities contributing data to the HIE organize their contributed data differently and it can challenging to find the expect desired data and clinical context within the big data environment commonly associated with health information exchanges.

I believe there is critical need for Federated Medical Record Collaboration Platforms within which medical providers and healthcare stakeholders could access clinically pertinent ePHI and participate in Meaningful Collaboration(TM) between medical providers, patients, payors and regulators. Virtual Viewbox Inc. has advocated for creation of a HIPAA compliant Healthcare Collaboration platform and supports the Meaningful Collaboration in Healthcare initiative. Virtual Viewbox Inc. operates on the RadCloud® private cloud platform, the first private cloud platform designed from the ground up to support meaningful collaboration between healthcare stakeholders.

In future posts I will discuss more specifics about healthcare IT interoperability.