HHS: Congress needs to help fight health info blocking

The federal official responsible for promoting electronic health information is asking for Congress' help to stop care providers blocking data sharing.

The federal official responsible for promoting electronic health information is asking for Congress’ help to stop care providers blocking data sharing.

Karen DeSalvo, Department of Health and Human Services’ national coordinator for health IT, testified Tuesday that the U.S. is ahead of other developed countries in the use of e-health records by hospitals and physicians, but she said a problem persists with hospitals and vendors blocking — whether intentionally or not — the sharing of that information, which limits the ultimate effectiveness of such technology.

Her office defines information blocking as “when persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information. These practices undermine efforts to advance the use of information and technology to improve health and health care,” according to its February annual report to Congress.

In many instances, health information blocking occurs when hospitals, providers or physicians are not fully educated on the digital sharing of records under the Health Insurance Portability and Accountability Act of 1996 and worry that they’d violate the law by sharing patients’ information with other providers giving them care, DeSalvo explained. Sometimes, hospitals or companies will do so for a competitive advantage, tacking on added sharing fees or writing gag clauses into business agreements.


“The data is not moving, and it’s because of a lack of understanding,” she said.

[Read more: ONC targets health providers engaged in information blocking]

“This is a new challenge we wouldn’t have had years ago when we did not have a digitized system,” DeSalvo told the House Oversight and Government Reform Committee’s subcommittees on IT and Health Care, Benefits, and Administrative Rules about information blocking. “It’s emerged since 2009 when the HITECH Act put ONC and our authorities into place.” 

ONC delivered a report to Congress last April that “generated a national conversation and set into motion some actions we’ve been taking in partnership with the Office of the Inspector General, also with the Office of Civil Rights, to see that we unblock data that has been collected in electronic health records,” DeSalvo said.

She pointed to information blocking as part of the reason that despite nearly all U.S. hospitals and 74 percent of physicians reporting the use of certified EHR technology — what DeSalvo called “a dramatic adoption” — in ONC’s February report, far fewer reported sharing those EHRs with each other.


Rep. Gerry Connolly, D-Va., wondered if legislation — possibly an amendment of the HITECH Act, the law passed in 2009 to give ONC its power — was needed to make health IT and record sharing more widespread, so Americans always have their health history available during a moment of care.

“You could jeopardize someone’s health without intending to,” Connolly said. “Is this a case where frankly we do need to look at some federal legislation. We regulate blood supply for safety. Well, electronic record keeping isn’t just a nice thing to have. In the digital age, it may be very critical to someone’s health and the care they get, especially in an emergency situation.” 

Overall, DeSalvo said ONC was working with its partners at HHS and on the state level to improve health information sharing. Still, “there are areas where we know that there may be some opportunity, like information blocking, where we might need some additional support,” she said.

In ONC’s budget request for fiscal year 2017, DeSalvo said she asked for some additional help from Congress to better define blocking and how it can deal with vendors who intentionally block information sharing. 

“We do believe that since the world has evolved, there’s a new need for us to have some additional opportunities to protect the people who are using the systems, but more importantly to protect the data of the consumers,” she said. 


It also comes down to better education on HIPAA in the digital age, she said, calling a lack of understanding the law and the consequential prevention of record sharing “in essence a form of blocking.”

“There is data to be freed, data to move, and the primary concern is to see that it’s there for that clinical moment of care when you need it,” DeSalvo said. “There’s probably also some additional needed attention and some additional supports to see that blocking is never a reason that people don’t get their data.”  

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