- One step necessary for advancing health IT interoperability is the development and implementation of health IT standards. Another is removing health data governance policies that are responsible for health information blocking.
"While not sufficient to ensure that we achieve broad-based interoperability of health IT systems (and realize the substantial potential value from the $28 billion public investment in these systems), reducing information blocking is not only a necessary step, it is perhaps the most critical step," writes Julia Adler-Milstein, PhD, of the University of Michigan School of Information on the Health Affairs Blog.
Adler-Milstein was one of several witnesses called to testify during a hearing convened by the Senate Committee on Health, Education, Labor, and Pensions in March. (It was also the very one responsible for revealing the price of health data exchange charged by Epic Systems.) Her most recent writing comes in response to the report the Office of the National Coordinator for Health Information Technology published last month on information blocking.
According to Adler-Milstein, the ONC report represents a step in the right direction:
While these challenges are difficult, and much work remains to convert the ONC report’s ideas into meaningful action, we should not discount the enormous step the report represents. There has long been recognition that current market conditions create incentives for providers and vendors to establish business practices that interfere with sharing and use of electronic health information. But there has been no term for these practices, and no framework for addressing them.
Despite her support for the information blocking report, Alder-Milstein has identified areas of the ONC work that could problematic when put into action. One criticism highlights the challenges associated with ONC's criteria for determining whether a healthcare provider or health IT vendor is responsible for information blocking.
"In concept these are good criteria, and they should capture the two key types of problematic behavior," she maintains. "In practice, these criteria are progressively harder to prove. Without being able to definitively identify whether or not something is occurring, it is extremely difficult to create effective policy remedies to combat it."
Another critique of the report centers on the definition of reasonable proposed by ONC.
"There are hard tradeoffs to be made when trying to balance the need to further the availability of electronic health information for better care, and maintaining the privacy and security of electronic health information," Alder-Milstein continues. "And reasonable people can disagree about what constitutes a reasonable tradeoff."
Additionally, the Assistant Professor at the School of Information also contends that the examples of information blocking presented by ONC are "clear-cut" and unlikely to play out as such in the wild where many current information blocking activities are "completely legal."
What in fact needs to change is a cultural shift at the highest levels of healthcare organizations that eventually recognizes to compete in a different way moving forward.
"When the C-suite truly believes that they can be most successful by competing on the basis of sharing and using data, rather than hoarding and controlling data, we will know that we have succeeded," Adler-Milstein concludes.