Reducing Information Blocking Practices in the U.S.

Generally speaking, information blocking refers to a wide range of practices that healthcare providers, healthcare IT professionals, and other related personnel use to effectively interfere with, discourage, or prevent the use or exchange of electronic health information or EHI. As healthcare professionals rely on EHI to treat their respective patients, any issues that arise when looking to retrieve this data can result in adverse consequences for said patients. What’s more, information blocking can also stunt the development of new healthcare products and services, as EHI is often used to research new treatments and cures that can be used to fight the various diseases and ailments that plague modern-day society.

What methods do healthcare providers use to block information?

Information blocking can occur through a number of different means and methods, both overt and subtle. For example, a particular healthcare facility may implement a policy that explicitly makes it difficult for other healthcare providers to access the PHI of their respective patients. Alternatively, information blocking can also occur as a result of contractual obligations or technical limitations, which make the sharing or transfer of information more costly or burdensome than such practices would be under ordinary circumstances. With all this being said, some common examples of practices and policies that could lead to information blocking include but are not limited to:

• Fees that make exchanging or transferring EHI cost-prohibitive.
• Organizational policies or contractual terms that either prevent the sharing of EHI outright, or greatly limit a healthcare provider’s ability to share such information.
• The intentional misrepresentation or misciting of healthcare privacy legislation such as HIPAA and the HITECH Act.
• Technology that is implemented in a non-standard manner which reduces the ability of healthcare providers to share and use EHI with other IT services, systems, and applications that follow standards that are nationally recognized.
• Healthcare providers and patients that become “locked-in” to a particular healthcare network or technology system, effectively making the EHI of these patients non-portable.

How common is information blocking?

The practice of information blocking is used most commonly among EHI vendors. As these vendors will be charged with managing and maintaining the EHIs of thousands of patients, they will obviously be the primary entity engaged in the practice of information blocking in many instances. However, all professionals within the healthcare industry can theoretically take steps to block the EHI of patients. To illustrate this point further, a study published by the Journal of the American Medical Informatics Association or JAMIA in January 2021 found that 55% of EHR vendors throughout the U.S. had been found to engage in some form of information blocking, while 30% of healthcare systems also engaged in similar practices.

Moreover, the JAMIA study also found that the method that EHR vendors used to block the EHI of patients was to set prices related to the transfer and disclosure of such information to unreasonably high amounts. For context, the study found that 42% of EHR vendors around the U.S. had utilized such tactics when looking to block patient information. Conversely, the study also found that many healthcare systems providers simply refused to share or disclose the EHI of their patients altogether, as this method was found to be used in 14% of all healthcare information systems. To this point, while studies conducted on any major topic or issue will undoubtedly be limited to a certain degree, the practice of information blocking is far more widespread than many U.S. citizens may believe.

How does the American public feel about information blocking?

As to be expected, many American citizens are vehemently opposed to information blocking practices. To demonstrate this further, a Pew Research Center survey that was conducted in September 2020 found that 81% of adults desired to share their EHI records at their own discretion, while 53% of adults that were surveyed said that they would like to have the option to download and share their EHI records on their own accord. Additionally, 87% of adults that were surveyed also expressed a desire to access certain images within their EHI records, such as X-rays and CT scans, among a host of others. To this end, public sentiment concerning the use of information blocking practices is particularly negative.

As advancements in technology have altered the fabric of every sector within the healthcare industry, it is understandable that practices such as information blocking would be viewed as problematic, as both healthcare providers and the patients that they serve rely on this information to function in their respective roles. To combat the issue of information blocking, the U.S. Congress enacted the 21st Century Cures Act in December 2016. While the law covers various aspects of the U.S. healthcare industry, such as the FDA drug approval process, medical research, and healthcare access and quality improvement, among others, the law also prohibits the practice of information blocking. As amendments to the law recently went into effect in 2020, it remains to be seen whether such legislation will deter healthcare providers from blocking the information of their patients.