Almost Half of Hospitals Report Instances of Perceived Information Blocking

After the initial enforcement of information blocking rules in April 2021, a considerable 42 percent of hospitals still reported observing what they perceived as information blocking.

They reported that different entities, such as healthcare providers, health information networks or exchanges, and health IT developers of certified health IT, may have been engaging in these practices.

These findings were drawn from a recent study published in the Journal of the American Medical Informatics Association (JAMIA), which used American Hospital Association survey data conducted between April and September 2021.

Under recent federal rules, healthcare organizations are now required to provide patients with unrestricted access to their complete health records in a digital format. The 21st Century Cures Act Final Rule introduced provisions against information blocking, designed to stop practices that obstruct or dissuade access, exchange, or use of electronic health information (EHI).

What began in April 2021 was supposed to be the start of the end to long waits, reliance on fax machines, and exorbitant fees for health records.

Researchers aimed to contribute to the existing knowledge on the prevalence of potential information blocking practices by assessing the perceptions of hospital leaders. Using a national survey of these leaders, the study examined the perceived prevalence of techniques that could constitute information blocking, both overall and by specific instances.

In 2021, 36 percent of the responding hospitals reported that they perceived healthcare providers as engaging in information blocking. However, a noticeable decrease was observed in 2022, with only 12 percent of hospitals reporting that healthcare providers were involved in practices that could be seen as information blocking.

“We think there are three likely explanations for the drop in perceived information blocking among healthcare providers,” an ONC blog post stated. “First, healthcare providers have responded to the information blocking rules by changing their practices to reduce possible information blocking.”

“It might be that developers more quickly adjusted practices in anticipation of the information blocking rule and similar changes by healthcare providers occurred only after the applicability date. New data from a forthcoming 2023 survey of health information exchanges may support this hypothesis.”

However, a slight increase in the perception of information blocking was noted elsewhere. More hospitals reported experiences of potential information blocking by developers of certified health IT in 2022 (22 percent) compared to 2021 (17 percent).

Similarly, perceived information blocking related to health information exchange went from 19 percent in 2021 to 20 percent in 2022.

A drop was noted in two specific types of healthcare provider practices that may constitute information blocking. Only 20 percent of hospitals reported that healthcare providers used artificial barriers to engage in perceived information blocking in 2022, down from 35 percent in 2021. Additionally, 15 percent of hospitals said that healthcare providers refused to exchange information in 2022, compared to 26 percent in the previous year.

Nevertheless, determining whether a practice constitutes information blocking depends on unique facts and circumstances. An action that interferes with the access, exchange, or use of EHI is not automatically deemed information blocking—unique factors about each action should be considered. For instance, physicians must have the requisite knowledge and intent to interfere with the access, exchange, or use of EHI.

Additionally, the 2022 data offers crucial insights into reports of information blocking. The findings revealed that just 1 percent of hospital leaders reported perceived information blocking to the ONC using the Report Information Blocking Portal. In contrast, 26 percent experienced perceived information blocking but have yet to report it.

Additionally, 57 percent said they did not experience information blocking within the past year, while 15 percent were still determining whether their hospital reported it.

The low rate of perceived information blocking reports corresponds with observations from the ONC reporting portal, where considerably fewer healthcare providers than patients report perceived information blocking. This infrequent reporting may suggest that the discrepancy is due more to healthcare providers under-reporting possible information blocking by others than to the true unobserved rate of information blocking in the field.

“Moving forward we plan to continue engaging patients, regulated entities, and other interested parties about practices that may constitute information blocking. Information we receive from interested parties across the healthcare landscape helps inform future educational materials and further engagement around information blocking, including our Information Blocking Claims: By the Numbers Quick Stat, which we aim to update monthly,” the blog post explained.

“We also have supported a survey, currently in the field, updating prior surveys on health information exchanges’ perceptions of practices that may constitute information blocking.”