Making electronic health information (EHI), or electronic health records (EHRs), more accessible is a key issue for clinicians focused on providing the highest standard of care. According to a 2018 report by the Office of the National Coordinator for Health Information Technology (ONC), only 36 percent of clinicians could access EHRs from outside providers at the point of care when health records were most critical.
Earlier this year, the Centers for Medicare and Medicaid Services (CMS) announced a new push to improve access to patient data. The ONC has also doubled down, issuing a proposed rule that defines information blocking between healthcare providers and patients. The rule, expected to go into effect later this year, carves out seven exceptions when clinicians and vendors might withhold patient data without penalty and imposes financial sanctions for unreasonable data blocking.
While efforts by the CMS and ONC stand to benefit clinicians and patients alike, critics warn that these proposed regulations could saddle healthcare administrators with higher costs, limit the software and services they use to access electronic health records and even open them up to data breaches.
What Is Information Blocking?
The proposed ONC rule defines information blocking as activities that are "likely to interfere with, prevent or materially discourage access, exchange or use" of EHRs. Implementing healthcare technologies that are unnecessarily cumbersome or complex, or that open the door to fraud, abuse or waste, may also constitute data blocking under the regulation.
The ONC's scenarios in which clinicians, health systems and vendors may withhold patient data without violating the rule include:
- To prevent harm to a patient.
- To promote EHI privacy.
- To foster EHI security.
- To reimburse reasonably incurred costs.
- In response to infeasible EHI requests.
- To license interoperability services on reasonable and nondiscriminatory terms.
- To maintain and improve health IT performance.
The organization says the rule is necessary to remove chokeholds on patient data. In a report to Congress, the ONC logged roughly 60 unsolicited complaints of potential information blocking in 2014 alone, as well as numerous anecdotal reports of healthcare systems, medical groups and IT vendors restricting access to patient data.
How Did We Get Here?
Passage of the federal Health Information Technology for Economic and Clinical Health Act (HITECH) in 2009 and the 21st Century Cures Act in 2016 sought to liberate EHRs to improve quality of care, promote public health and reduce healthcare costs. Today, according to ONC's report to Congress, more than 60 percent of eligible hospitals are routinely exchanging patient EHRs with physicians, and clinicians with greater access to EHRs report improvement in overall patient health.
Despite the benefits of sharing patient data, from improved health outcomes to increased efficiency, the ONC notes that confusion about the privacy requirements of HIPAA has prompted some clinicians to withhold patient data unnecessarily for fear of violating the law. At the root of much of this resistance are legitimate privacy concerns: The risk of potential privacy breaches is considerable if patient data rules are misunderstood or adopted incorrectly.
How Data Sharing Can Improve Healthcare Quality
Last year, the European Commission proposed cross-border health information exchanges similar to the ONC's to encourage the secure sharing of patient data throughout EU member states. It's too soon to gauge how its rollout might serve as a lesson to clinicians on this side of the Atlantic, but research suggests countries that prioritize interoperability and data sharing rank higher in measures of healthcare quality. A systematic analysis of the 2016 Global Burden of Disease Study published in Lancet found that out of 195 national healthcare systems, five out of the eight wide-scale EHR adopters ranked in the top 20 nations for healthcare system performance.
Until the ONC and similar rules go into effect, patient data sharing is largely up to the discretion of private practice owners. Clinicians should stay up to date on EHR research so that they can make informed data decisions in the interest of their patients and practice.