March 2017 (Volume 95)

Information Blocking: Is It Occurring and What Policy Strategies Can Address It?

March 2017 | Julia Adler-Milstein, Eric Pfeifer | Original Investigation

Policy Points:

  • Congress has expressed concern about electronic health record (EHR)
    vendors and health care providers knowingly interfering with the electronic
    exchange of patient health information. These “information
    blocking” practices would privately benefit vendors and providers but
    limit the societal quality and efficiency benefits from EHR adoption.
  • We found that information blocking is reported to frequently occur
    among EHR vendors as well as hospitals and health systems, and that
    it is perceived to be motivated by opportunities for revenue gain.
  • Because information blocking is largely legal today, the most effective
    policy response likely involves a combination of direct enforcement and
    the altering of market conditions that promote information blocking.

Context: Congress has raised concerns about providers and electronic health record (EHR) vendors knowingly engaging in business practices that interfere with electronic health information exchange (HIE). Such “information blocking” is presumed to occur because providers and vendors reap financial benefits, but these practices harm public good and substantially limit the value to be gained from EHR adoption. Crafting a policy response has been difficult because, beyond anecdotes, there is no data that captures the extent of information blocking.

Methods: We conducted a national survey of leaders ofHIE efforts who work to enable HIE across provider organizations. We asked them about the frequency of information blocking, its specific forms, and the effectiveness of various policy strategies to address it.We received responses from 60 individuals (57% response rate).We calculated descriptive statistics across responses.

Findings: Half of respondents reported that EHR vendors routinely engage in information blocking, and 25% of respondents reported that hospitals and health systems routinely do so. Among 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. Increasing transparency of EHR vendor business practices and product performance, stronger financial incentives for providers to share information, and making information blocking illegal were perceived as the most effective policy remedies.

Conclusions: Information blocking appears to be real and fairly widespread. Policymakers have some existing levers that can be used to curb information blocking and help information flow to where it is needed to improve patient care. However, because information blocking is largely legal today, a strong response will involve new legislation and associated enforcement actions.

Author(s): Julia Adler-Milstein and Eric Pfeifer

Keywords: electronic health records, interoperability, health policy, incentives.

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Volume 95, Issue 1 (pages 117–135)
DOI: 10.1111/1468-0009.12247
Published in 2017