Selected Podcast
Information Blocking Prevention: Clearing the Path for Interoperability
Secure sharing of health information is critical as technology advances. Lori Manteufel, Health IT Project Specialist, discusses information blocking.
Featuring:
Lori Manteufel, BBA
Lori Manteufel is a Health IT Project Specialist at MetaStar. Since April 2015, Lori has worked primarily in the Health IT Extension Program assisting Wisconsin Medicaid Providers to improve health IT maturity and participate in the Medicaid Promoting Interoperability Program. Transcription:
Caitlin Whyte (Host): As health care information technology continues to evolve, secure, appropriate, and efficient sharing of electronic health information is critical. Today, we’re talking information blocking prevention and how we can clear the path for interoperability. To break this down for us, we have Lori Manteufel. She is a Health IT Project Specialist at MetaStar and is going to tell us more about information blocking. This is MetaStar Health IT Radio. I’m your host, Caitlin Whyte. So, Lori, what is information blocking?
Lori Manteufel. BBA (Guest): The Office of the National Coordinator of Health IT, better known as the ONC, defines information blocking as when clinicians or practices knowingly and unreasonably interfere with the electronic exchange or use of electronic health information. Here’s a real world example, just to put some context around it. Let’s say that I’m a patient, and I want to send my recent visit summary over to a provider in a different health system, for example, for a second opinion using the patient portal. It could be considered information blocking if the clinic I originally saw had configured their electronic health record or EHR in a way that prohibits me from sharing that information outside of their specific health system.
As you can imagine, given the increased focus on sharing health information electronically, which is also known as that buzzword “interoperability” that we hear about, you can really see why information blocking is a big deal. As a matter of fact, the ONC’s report to Congress back in 2015, cited information blocking as one of the primary barriers to achieving interoperability.
Host: Why is information blocking especially important for clinicians who participate in the Medicaid Promoting Interoperability or the Merit-based Incentive Program?
Lori: Starting in 2017, each year clinicians or eligible professionals are required to attest that they do not participate in information blocking by attesting to basically a series of yes or no questions. Clinicians or eligible professionals must attest, and I’ll give sort of the list of this, is that first of all they do not knowingly and willfully take action to limit or restrict the interoperability of certified EHR technology. And that they implement technology standards in a way that’s reasonably calculated to ensure that their EHR was connected in accordance with applicable law and standards. Specifically, that they are able to use the information and share it in a trusted bi-directional exchange, specifically of structured electronic health information.
Basically, what I recommend to practices is that they implement their EHR in the way that the vendor has recommended. The other piece of it is, is that they respond in good faith and in a timely manner to requests to retrieve or exchange electronic health information. The Medicaid Health IT Extension Program does have a tip sheet available online to really help clinicians understand these questions and what the answers to those really mean in terms of being able to successfully report or attest to those various government programs.
Host: What steps should I take to prevent information blocking at our practice?
Lori: Let me start off by saying, clinicians or even practice managers, are not expected to be health IT experts. But they are required to act in good faith when implementing and using a certified EHR to exchange health information. Which is part of the certification process for the EHR itself and so, that’s why in the real world, and especially in smaller practices; the one thing that I really emphasize is just the need to follow your vendor’s recommendations and implement the various pieces of it in the way that your vendor recommends.
However, information blocking does occur and just some examples of some common types of information blocking that you may experience or maybe can think about is using a system to limit information sharing in order to control referrals, especially outside of health systems. And failing to implement functionality and required standards that your vendor recommends so this will allow for sharing of information. And then failing to provide information that has been requested electronically by another provider seeking to provide care to that patient. Another example would be mandating a policy preventing any lab results from being shared through the portals to a patient. So, anything along those lines where you are saying, “No, I don’t want to share information electronically”
or someone is telling you no, we don’t share information pertinent health care information with other providers. That really is what information blocking is. And so those are some of the ways that you can really prevent from getting into that sort of situation.
Host: You’ve mentioned that information blocking is an area that is increasingly important as we move toward the goal of interoperability health data. What is on the horizon?
Lori: In early March the Cures final rule was published that provides much more guidance and understanding around that. So I just wanted to highlight some of the items of that final rule actually emphasizes and it defined eight specific exceptions that offer actors such as health care providers and health IT developers certainty that when their practices are acting that they meet the conditions of either one or more of the exceptions and thus really helps them define what information blocking really is and is not and those exceptions.
There are eight exceptions and they're broken into two general categories. Those are exceptions that involve not fulfilling request to access, exchange, or use electronic health information and exceptions that involve procedures for fulfilling requests to access, exchange, or use electronic health information and those are preventing harm exceptions, privacy exceptions, security exceptions, infeasibility exceptions, health IT performance exceptions and then as well as content and manner fees and licensing. I did just want to emphasize that each one of these really has a lot of explanations behind it that health care providers need to look at, including the objectives and specific key conditions in order to really know that you're fulfilling that exception or that you fall within that.
I just wanted to point out that just one security exception as sort of illustrating that and for that specifically the ONC has defined that it will not be considered information blocking for an actor to interfere with the access, exchange, or use of electronic health information in order to protect the security of EHI provided that certain conditions are met and those condition in this particular one is that the practice in question must be directly related to safe guarding the confidentiality, integrity, and availability of the information tailored to specific security risks and implemented in a consistent and non-discriminatory manner. And in this case health care organization want to make sure that the practice is implementing a qualifying organizational security policy or some criteria for that security determination. So I think on the horizon there's going to be a lot more definition around this because the sharing of information is so very, very important in an interoperable world.
Host: What should I do if I suspect that another organization willfully prevents the interoperability of health information data?
Lori: That is something that you most certainly would want to report so that it can be investigated and potential cases of information blocking should be reported through the ONC through the health IT complaint form that can be found on www.healthit.gov.
Host: That leads me into my last question here. Where can listeners go for more information or to receive assistance?
Lori: The Medicaid Health IT extension program for Wisconsin Medicaid providers can provide additional resources including as I mentioned previously that attestation tip sheet. And this can be found on our website at www.metastar.com. We invite listeners to reach out to us with questions around information blocking or anything else that is health IT related. We have a team of local professionals that most certainly can help you.
Host: Great well Lori I think that about wraps it up. Is there anything else you want to add?
Lori: The bottom line is, is that sharing of health information across settings is so important to improving patient care these days. Everyone agrees with that. And so, the biggest thing is just to pay attention to how your EHR works and is implemented the way your vendor recommends.
Host: That was Lori Manteufel, a Health IT Project Specialist at MetaStar. For more information on this topic and to access the resources mentioned, please visit www.metastar.com/podcast. If you enjoyed this episode, you can find more like it in our podcast library and be sure to share this episode on all your social channels. This is MetaStar Health IT Radio. I’m Caitlin Whyte. Thanks for joining us.
Caitlin Whyte (Host): As health care information technology continues to evolve, secure, appropriate, and efficient sharing of electronic health information is critical. Today, we’re talking information blocking prevention and how we can clear the path for interoperability. To break this down for us, we have Lori Manteufel. She is a Health IT Project Specialist at MetaStar and is going to tell us more about information blocking. This is MetaStar Health IT Radio. I’m your host, Caitlin Whyte. So, Lori, what is information blocking?
Lori Manteufel. BBA (Guest): The Office of the National Coordinator of Health IT, better known as the ONC, defines information blocking as when clinicians or practices knowingly and unreasonably interfere with the electronic exchange or use of electronic health information. Here’s a real world example, just to put some context around it. Let’s say that I’m a patient, and I want to send my recent visit summary over to a provider in a different health system, for example, for a second opinion using the patient portal. It could be considered information blocking if the clinic I originally saw had configured their electronic health record or EHR in a way that prohibits me from sharing that information outside of their specific health system.
As you can imagine, given the increased focus on sharing health information electronically, which is also known as that buzzword “interoperability” that we hear about, you can really see why information blocking is a big deal. As a matter of fact, the ONC’s report to Congress back in 2015, cited information blocking as one of the primary barriers to achieving interoperability.
Host: Why is information blocking especially important for clinicians who participate in the Medicaid Promoting Interoperability or the Merit-based Incentive Program?
Lori: Starting in 2017, each year clinicians or eligible professionals are required to attest that they do not participate in information blocking by attesting to basically a series of yes or no questions. Clinicians or eligible professionals must attest, and I’ll give sort of the list of this, is that first of all they do not knowingly and willfully take action to limit or restrict the interoperability of certified EHR technology. And that they implement technology standards in a way that’s reasonably calculated to ensure that their EHR was connected in accordance with applicable law and standards. Specifically, that they are able to use the information and share it in a trusted bi-directional exchange, specifically of structured electronic health information.
Basically, what I recommend to practices is that they implement their EHR in the way that the vendor has recommended. The other piece of it is, is that they respond in good faith and in a timely manner to requests to retrieve or exchange electronic health information. The Medicaid Health IT Extension Program does have a tip sheet available online to really help clinicians understand these questions and what the answers to those really mean in terms of being able to successfully report or attest to those various government programs.
Host: What steps should I take to prevent information blocking at our practice?
Lori: Let me start off by saying, clinicians or even practice managers, are not expected to be health IT experts. But they are required to act in good faith when implementing and using a certified EHR to exchange health information. Which is part of the certification process for the EHR itself and so, that’s why in the real world, and especially in smaller practices; the one thing that I really emphasize is just the need to follow your vendor’s recommendations and implement the various pieces of it in the way that your vendor recommends.
However, information blocking does occur and just some examples of some common types of information blocking that you may experience or maybe can think about is using a system to limit information sharing in order to control referrals, especially outside of health systems. And failing to implement functionality and required standards that your vendor recommends so this will allow for sharing of information. And then failing to provide information that has been requested electronically by another provider seeking to provide care to that patient. Another example would be mandating a policy preventing any lab results from being shared through the portals to a patient. So, anything along those lines where you are saying, “No, I don’t want to share information electronically”
or someone is telling you no, we don’t share information pertinent health care information with other providers. That really is what information blocking is. And so those are some of the ways that you can really prevent from getting into that sort of situation.
Host: You’ve mentioned that information blocking is an area that is increasingly important as we move toward the goal of interoperability health data. What is on the horizon?
Lori: In early March the Cures final rule was published that provides much more guidance and understanding around that. So I just wanted to highlight some of the items of that final rule actually emphasizes and it defined eight specific exceptions that offer actors such as health care providers and health IT developers certainty that when their practices are acting that they meet the conditions of either one or more of the exceptions and thus really helps them define what information blocking really is and is not and those exceptions.
There are eight exceptions and they're broken into two general categories. Those are exceptions that involve not fulfilling request to access, exchange, or use electronic health information and exceptions that involve procedures for fulfilling requests to access, exchange, or use electronic health information and those are preventing harm exceptions, privacy exceptions, security exceptions, infeasibility exceptions, health IT performance exceptions and then as well as content and manner fees and licensing. I did just want to emphasize that each one of these really has a lot of explanations behind it that health care providers need to look at, including the objectives and specific key conditions in order to really know that you're fulfilling that exception or that you fall within that.
I just wanted to point out that just one security exception as sort of illustrating that and for that specifically the ONC has defined that it will not be considered information blocking for an actor to interfere with the access, exchange, or use of electronic health information in order to protect the security of EHI provided that certain conditions are met and those condition in this particular one is that the practice in question must be directly related to safe guarding the confidentiality, integrity, and availability of the information tailored to specific security risks and implemented in a consistent and non-discriminatory manner. And in this case health care organization want to make sure that the practice is implementing a qualifying organizational security policy or some criteria for that security determination. So I think on the horizon there's going to be a lot more definition around this because the sharing of information is so very, very important in an interoperable world.
Host: What should I do if I suspect that another organization willfully prevents the interoperability of health information data?
Lori: That is something that you most certainly would want to report so that it can be investigated and potential cases of information blocking should be reported through the ONC through the health IT complaint form that can be found on www.healthit.gov.
Host: That leads me into my last question here. Where can listeners go for more information or to receive assistance?
Lori: The Medicaid Health IT extension program for Wisconsin Medicaid providers can provide additional resources including as I mentioned previously that attestation tip sheet. And this can be found on our website at www.metastar.com. We invite listeners to reach out to us with questions around information blocking or anything else that is health IT related. We have a team of local professionals that most certainly can help you.
Host: Great well Lori I think that about wraps it up. Is there anything else you want to add?
Lori: The bottom line is, is that sharing of health information across settings is so important to improving patient care these days. Everyone agrees with that. And so, the biggest thing is just to pay attention to how your EHR works and is implemented the way your vendor recommends.
Host: That was Lori Manteufel, a Health IT Project Specialist at MetaStar. For more information on this topic and to access the resources mentioned, please visit www.metastar.com/podcast. If you enjoyed this episode, you can find more like it in our podcast library and be sure to share this episode on all your social channels. This is MetaStar Health IT Radio. I’m Caitlin Whyte. Thanks for joining us.