Connecticut recently became the first state to make electronic health information blocking illegal and its Office of the Attorney General is looking into such allegations that include Epic Systems and major hospital-based networks in the state.

Independent medical groups in the state are accusing large health systems of using their EHRs (Electronic Health Records) as a “tool to coerce practices to join them while punishing those who remain out of network,” as first reported by Politico. According to the report, critics charge that Epic—which controls more than 50 percent of the state’s hospital EHR market—is in effect collaborating with the hospital networks to pressure smaller practices to “sell out” by blocking the sharing of health information.

In response to a query from Information Management’s sister publication Health Data Management, the Office of the Attorney General made the following statement: “We do not at this time have an active investigation into any specific target or targets. However, we are aware of this issue, are interested in its impact on the healthcare market in Connecticut, and are continuing to evaluate it. We would decline further comment at this time.”

“Epic categorically does not engage in data blocking, nor are we aware of any customers that do,” said Erika Koch, spokeswoman for the EHR vendor, in a written statement. “We are all, as an industry, working toward an ideal state of seamless interoperability. With today’s interoperability standards, a clinical summary can be and is shared between health systems and independent providers. Given the depth and complexity of a modern clinical record, the fact that not all of a patient’s information is interoperable should not be confused with willful withholding.”

In April, the Office of the National Coordinator for Health IT sent a report to Congress on the problem of electronic health information blocking, concluding that some providers and vendors have created technical, legal and business barriers between their EHR systems and other systems to interfere with access to information.

In addition, last month the Department of Health and Human Service’s Office of the Inspector General issued an alert to the healthcare industry warning that information blocking may affect EHR safe harbor protections under the federal anti-kickback statute. However, according to the HIMSS Electronic Health Record Association (EHRA), the problem with information blocking is more perception than reality.

In late September, EHRA sent a letter to National Coordinator for Health IT Karen DeSalvo, M.D., making the case that “there are a limited number of anecdotes of information blocking, but determining which are truly information blocking per the definition is not easy.”

While there is the perception that information blocking exists, the EHR trade association states in its letter to DeSalvo that “in many cases, there is no intent to interfere, but rather a series of events that result in less data exchange than desired by some parties.” As a result, EHRA concludes: “We run the risk of overreaction to what appear to be isolated incidents.”

Yet, in its report to Congress, ONC charged that some EHR vendors are preventing the exchange of health information with competitors and that some providers engage in information blocking to control referrals and enhance their market dominance over competitors.

Research firm KLAS recently conducted a survey to gauge provider views on the interoperability strengths and weaknesses of EHR vendors. In the survey, 98 percent of providers indicated they are willing to share data, while only 82 percent report their main competitor to be similarly willing.

At the same time, KLAS states “no provider reported a circumstance in which a vendor contractually or otherwise willingly impeded information sharing, aside from the business models around profitability” and that providers “overwhelmingly report their vendors to be willing to help them share but say business revenue models and lack of technical resources often get in the way.”

Adam Gale, president of KLAS, scoffs at the idea of information blocking on the part of EHR vendors. “We work with a lot of these vendors, and I just don’t see it,” says Gale. “If charging to set up interfaces and integration is information blocking, then every vendor does it. Every vendor charges one way or another for this.”

Still, according to ONC, current economic and market conditions “create business incentives for some persons and entities to exercise control over electronic health information in ways that unreasonably limit its availability and use.”

The agency also asserts that such “business practices, though they may arguably advance legitimate individual economic interests, interfere with the exchange of electronic health information in ways that raise serious information blocking concerns.”

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