Overcoming barriers to data exchange and interoperability
This article is the fourth in a series on meeting information blocking requirements and understanding why regulators have embraced a loose definition of electronic health information, or EHI. Future articles will look at technology’s role in improving care coordination through data sharing, and at how third-party partners can augment strategies for overcoming “last mile” barriers to interoperability and data exchange.
In its quest to improve data exchange and interoperability, the Office of the National Coordinator for Health IT (ONC) has made no secret that it won’t tolerate information blocking. There’s good reason for this: Leading up to the final rule’s implementation, separate surveys showed that 36% of hospitals and 30% of health information exchanges observed providers engaging in some type of information blocking.
Examples of information blocking tend to relate to how an organization uses clinical technology or to its policies for how and when information is shared, and with whom.
On the technology side, providers may make it difficult for patients to access their records by not allowing data exports from portals or other patient-facing software products. Or, an organization may decide it’s too difficult or costly to attempt to share data with any entity using a different electronic health record (EHR) system.
On the policy side, organizations can be guilty of information blocking in several ways.
- Require clinicians to review EHI before sharing it with patients.
- Fail to provide timely responses to patient or provider requests for EHI.
- Charge a fee for patients to export data from portals or other products.
- Place limits on how long EHI is available.
- Restrict certain medical specialists from accessing EHI.
- Implement technology that doesn’t support information sharing.
With the information blocking rule in place, and with enforcement (and financial penalties) due any day now, providers need to ensure they’re taking the right steps to enable data exchange as ONC has defined it. Here’s what organizations should be doing.
Train staff on new regulations. Anyone who interfaces with patients or other providers, whether from a clinical or administrative perspective, should know how EHI is now defined and how it must be made available.
Adjust organizational culture. Emphasize that information blocking is only allowed under certain circumstances defined by law. Workers should feel comfortable reporting a colleague who may be withholding information, even if it’s unintentional.
Revisit data-sharing policies. There’s significant overlap among the HIPAA Privacy Rule, the HIPAA Security Rule, and the information blocking rule. Privacy practices, policies about access to medical records, and even Business Associate Agreements will likely need revision.
Locate EHI. One key to ensuring that entities receive all information to which they’re entitled is to know where it is. Remember that EHI can exist outside the EHR in lab, imaging, pharmacy, and billing systems. Make sure these systems can export the appropriate information when EHI access has been requested.
Talk to vendors. Just because technology is certified doesn’t mean it automatically meets information blocking rule requirements. Make sure vendors abide by the letter and spirit of the regulation. The use of open application programming interfaces for data exchange is one telltale sign that data can be shared.
Keep looking ahead. ONC has proposed updates to the information blocking final rule; providers should note revised definitions of exceptions. In addition, vendors are routinely updating products to better support data sharing. Keeping abreast of such changes can ensure that organizations maintain up-to-date – and compliant – policies and technology tools.
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