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Information Blocking in the Healthcare System

Information Blocking in the Healthcare System

By: Bridget Keaton
September 15 2021

Easy access to information is at the heart of the 21st Century Cures Act.  With many elements of the law carefully crafted to empower citizens via greater access to their health data and records, Information Blocking rules become necessary aspects of the law.  To ensure that providers are in compliance with data access regulations, the Information Blocking rules have been outlined and implemented for accountability.  They stand to ensure the Price Transparency Act and Interoperability Rules could not be avoided or bypassed.  This article will discuss the logistics of the Information Blocking rules, the benefits for the healthcare consumer, and the exceptions that exist.  

What is Information Blocking?  

Information blocking is a practice that interferes with access, exchange, or use of health data. Data is occasionally blocked for various reasons by the provider, certified health IT developers, a health information network, or a health information exchange.  Information blocking may occur through implementing health IT in non-standard, intentionally cumbersome ways that make the access and navigation of data difficult or restrictive.  As a result, the practice of information blocking can lead to fraud, waste, and abuse, or obstruct innovations, hinder health information advancements, and slow the delivery of care.  When data is blocked, the patient cannot receive their health records or they may be limited, constituting an infraction. With information blocking, healthcare consumers are negatively impacted as their access to data becomes limited, stress increases and medical procedures may be repeated unnecessarily.   

Why Outline Information Blocking Rules and what are the Benefits to Implementing Rules?  

The 21st Century Cures Act was created with the intention to bring about greater data access to healthcare consumers, promote medical and technological advancements, and create competition within healthcare. As a massive law, these goals must be addressed and rules constructed to enable a successful execution of the law.  Each element of the Cures Act addresses data access in a different manner and the Information Blocking rules exist to protect Interoperability and Price Transparency and ensure that the expectations for data transfer are laid out.  The Information Blocking rules promote the accessibility of patient data access and provide rules, logistics, definitions, and consequences for noncompliance.    

 While the Price Transparency Act and Interoperability Rules include their own sets of regulations, the Information Blocking rules act as an umbrella to outline the higher expectations of compliance. As interoperability comes into effect in the United States, the transfer of data will become a regular practice.  This new law presents an opportunity for various actors such as electronic health record (EHR) companies, health IT developers, or physicians to block the transfer of data for numerous reasons.  To prevent this, Information Blocking rules outline how Interoperability regulations should be met, furthering the implementation of interoperability practices.  Similarly, Information Blocking rules promote the Price Transparency Act and prevent hospitals from keeping costs in opaque systems. These Information Blocking rules are created to ensure the aspects of the Cures Act may function as intended.    

 Information Blocking rules are in effect to ensure that companies do not create burdensome barriers for the transfer of patient data.  With an efficient transfer of data and Information Blocking rules outlined, healthcare consumers benefit. Patients become empowered to make better medical decisions and it is ensured that their providers have access to their full medical history, promoting better care.  Rapid access to data provides a patient with comprehensive medical history which can prevent duplicate services, vaccinations, tests, etc.  Not only is the patient experience elevated but the employers also benefit as duplicative services are minimized, meaning costs become reduced.  Information Blocking rules have the capacity to save costs, time, resources, and give the patient peace of mind knowing that their provider has a complete picture of their previous care and decisions.   

Penalties for Information Blocking  

In the case of an information blocking violation, the patient may report a claim through the Office of the National Coordinator for Health Information Technology (ONC).  The claim will then be reviewed and passed to the HHS Office of the Inspector General (OIG) who then is responsible for investigating the claims ("Information Blocking FAQ’s").  At this time, there is no penalty for physicians who engage in information blocking; however, there is a $1 million fine per instance for any health IT developers who block information ("Cures Act Information"). Over the next two years, the OIG will outline penalties for physicians as well.    

What are the Exceptions to the Information Blocking Rules?  

While The Cures Act has set out to create more efficient data access for stronger decision making, there are some exceptions to the rule.  These exceptions are meant to “identify reasonable and necessary activities that do not constitute information blocking” and are separated into two distinct classes (“Information Blocking” [Healthit.gov.]). The first is the class of “exceptions that involve not fulfilling requests to access, exchange, or use electronic health information (or EHI)” and the second is “exceptions that involve procedures for fulfilling requests to access, exchange, or use EHI” (“Information Blocking” [Healthit.gov]).  

Class one: Not fulfilling requests to access, exchange, or use electronic health information  

  • Preventing harm: If blocking information prevents harm to a patient or another person, then it is not considered information blocking and penalties will not be administered.  

  • Privacy: If blocking information protects the privacy of a patient (ex. sharing data would violate HIPAA or a state’s privacy law), then it is not considered information blocking and penalties will not be administered.  

  • Security: If blocking information protects the security of a patient’s electronic health information (EHI), then it is not considered information blocking and penalties will not be administered.  

  • Infeasibility: It is not considered information blocking if the request to access, exchange, or use data is infeasible and penalties will not be administered.  

  • Health IT performance: It is not considered information blocking if the data is made temporarily unavailable or if the health IT is degraded in performance for the benefit of the overall performance of the health IT system.  

Class two: Procedures for fulfilling requests to access, exchange, or use EHI  

  • Content and Manner: The actor has the autonomy to decide the manner in which they will fulfill the request to access, exchange or use EHI data.  Additionally, it is not considered information blocking if the actor limits the content of its response to a request to access, exchange or use EHI.  

  • Fees: It is not considered information blocking if an actor charges fees, including fees that result in a reasonable profit margin, for accessing, exchanging or using electronic health information.   

  • Licensing: It is not considered information blocking if an actor implements licensing technology for accessing, exchanging or using electronic health information (“Information Blocking” [ONC’s Cures Act Final Rule]).

Provided that certain conditions are met, if any of these eight reasons above are compromised in order to comply with data exchange, they are exempt from meeting Information Blocking standards. As challenges to the conditions are brought forward and boundaries are pushed overtime, the conditions may change and the exceptions may evolve.    

 The 21st Century Cures Act strives to foster accessibility, autonomy, and authority to healthcare consumers. As many aspects of The Cures Act focus on the seamless exchange of data, so too must rules be created for clarity.  The Information Blocking Rule reinforces the importance of enabling patients’ access to their personal health records and validates their demands for compliance.  As the Information Blocking rules come to fruition, the benefits intended in the 21st Century Cures Act will have the opportunity to empower the individual and work towards a stronger healthcare system.   

Sources: 

“Cures Act Information Blocking Rule Take Effect”. ForeSee Medical. ForeSee Medical.  26 March, 2021. https://www.foreseemed.com/blog/information-blocking-final-rule.  Accessed 30 September, 2021  

“Information Blocking”.  Healthit.gov. United States Government. 19 March, 2021. https://www.healthit.gov/topic/information-blocking.  Accessed 30 September, 2021  

“Information Blocking”.  ONC’s Cures Act Final Rule. United States Government.  https://www.healthit.gov/curesrule/final-rule-policy/information-blocking.  Accessed 30 September, 2021   

“Information Blocking FAQ’s” ONC’s Cures Act Final Rule. United States Government. https://www.healthit.gov/curesrule/resources/information-blocking-faqs.  Accessed 30 September, 2021