ONC: 42% of Hospitals Reported Perceived Information Blocking in 2021

Over 40 percent of hospitals observed practices they perceived to constitute information blocking in 2021, according to an ONC survey of 2,092 nonfederal acute care hospitals.

Researchers fielded the survey shortly after the April 2021 applicability date of the 21st Century Cures Act Final Rule’s information blocking provisions, which prohibit interfering with, preventing, or materially discouraging access, exchange, or use of electronic health information (EHI).

Hospitals often identified other healthcare providers engaging in practices that may constitute information blocking.

This finding contrasts with evidence from two surveys of health information exchanges (HIEs) conducted in 2015 and 2019 that found health IT developers were substantially more likely to engage in practices that may constitute information blocking than healthcare providers.

The ONC researchers suggested two likely explanations for this discrepancy.

One explanation is that health IT developers have improved their information sharing behaviors or altered contractual terms to better allow information sharing in recent years, perhaps in anticipation of the information blocking regulation.

An additional explanation is that perceptions of information blocking are related to the competitive dynamics of stakeholders.

For example, hospital respondents were more likely than previous HIE respondents to perceive information blocking by other providers, perhaps because hospitals deal with healthcare providers more directly in circumstances where competition may be at play.

“A parallel dynamic may exist in data from claims submitted to ONC’s Report Information Blocking Portal, in which the plurality of claims appeared to have been submitted by patients, and the plurality of claims cited healthcare providers as possibly blocking information,” the researchers wrote.

Since patients engage more often with healthcare providers than health IT developers or HIEs, they may be more likely to perceive healthcare providers (including hospitals) as information blocking, they added.

In comparison, HIEs work to provide services for healthcare providers, and many HIEs have achieved sustainability through the support of hospitals inclined to share information. However, HIEs can perceive health IT developers as competitors or impediments to growth.

Nearly 20 percent of hospitals reported that health IT developers had engaged in perceived information blocking. While lower than reported perceived information blocking by healthcare providers (36 percent), these data indicate that practices feel like information blocking by health IT developers is not inconsequential.

Hospitals not using market-leading EHRs were more likely to indicate information blocking from health IT vendors.

“This is consistent with work that has shown that physicians using EHRs with lower market share were less likely to engage in interoperability,” the authors wrote.

“Developers with fewer customers likely need to spread the cost of enabling exchange over a smaller customer base and may therefore seek to minimize additional work to enable interoperability or to more aggressively maximize revenue for that work,” they added.

The practices of larger health IT developers used by other organizations, which may not facilitate interoperability with smaller developers, could also drive the correlation.

The researchers conducted a post hoc analysis based on whether the hospital used the most dominant EHR in its local market.

However, they found no difference in reported information blocking based on whether the hospital used the local market-leading EHR.

This finding contrasts with prior research that indicated hospitals using local market-leading EHR reported greater HIE capabilities than other hospitals in their market.

The ONC study also revealed that for-profit hospitals were almost three times more likely to report experiencing information blocking from other healthcare providers than nonprofit hospitals.

“We speculate that healthcare providers may have been reluctant to share information with for-profit hospitals because of concerns about their approach to practice or competitive orientation,” the researchers said.

They suggested for-profit hospitals may be more likely to report perceived information blocking because of their more aggressive approach to obtaining information from other entities.

“Notably, the share of the market dominated by for-profit hospitals was not correlated with rates of perceived information blocking, which might indicate that our finding is not driven by the information sharing (ie, sending or making available) related behavior of for-profit hospitals,” the researchers wrote.