retrieved from nytimes.com | By ROBERT PEAR | MAY 26, 2015
WASHINGTON — Since President Obama took office, the federal government has poured more than $29 billion into health information technology and told doctors and hospitals to use electronic medical records or face financial penalties.
But some tech companies, hospitals and laboratories are intentionally blocking the electronic exchange of health information because they fear that they will lose business if they share information on patients with competing providers, administration officials said. In addition, officials said, some sellers of health information technology try to “lock in” customers by making it difficult for them to switch to competing vendors.
“We have received many complaints of information blocking,” said Dr. Karen B. DeSalvo, the national coordinator for health information technology. “We are becoming increasingly concerned about these practices.”
The White House and Congress are looking for ways to ensure a freer flow of information.
Mr. Obama has made computerizing patients’ medical records a priority of his administration. Four weeks after taking office, he signed an economic stimulus bill that offered bonus payments to doctors and hospitals adopting the new technology. He said that it would save money by reducing waste and duplication, and that it could save lives by improving care.
Many doctors and hospitals have begun using electronic medical records, but providers with different systems are often unable to share data in electronic form.
“We have electronic records at our clinic, but the hospital, which I can see from my window, has a separate system from a different vendor,” said Dr. Reid B. Blackwelder of Kingsport, Tenn., chairman of the American Academy of Family Physicians. “The two don’t communicate. When I admit patients to the hospital, I have to print out my notes and send a copy to the hospital so they can be incorporated into the hospital’s electronic records.”
Dr. Peter E. Masucci, a pediatrician in Everett, Mass., said he had been trying for more than five years to connect his electronic medical records with those of a hospital where he often sends patients. “It’s never happened,” he said.
In a report to Congress, Dr. DeSalvo gave several other examples:
- A doctor may have to pay exorbitant fees to transfer information on patients from the medical record system of one vendor to that of another.
- A network of doctors and hospitals refuses to share electronic information on patients with providers outside the network, even when the information is needed to treat patients and sharing the data is allowed by federal rules.
- Doctors obtain laboratory services and health records technology from one company, which will not let them connect to a competing laboratory, even though the connection is technically feasible and the doctors are willing to pay for it.
The Obama administration said that some hospitals and technology companies appeared to be using electronic health records as part of a business strategy to “enhance their market dominance.” But Dr. DeSalvo said it was difficult to discover the details of such arrangements because some information technology companies “prohibit customers from reporting or even discussing” terms of their contracts.
Dr. DeSalvo’s office is working with the Federal Trade Commission, which enforces antitrust and consumer protection laws. Tara Isa Koslov, a lawyer at the commission, said her agency was “paying close attention to developments in health I.T. markets and the reports of information blocking.”
Peter J. DeVault, a vice president of the Epic Systems Corporation in Verona, Wis., one of the largest suppliers of software for electronic health records, said: “We do not participate in any activities that could be described as information blocking. To our knowledge, these activities are very rare, if they exist at all.”
But Dan Haley, vice president of a competing company, Athenahealth, based in Watertown, Mass., said: “This is a serious problem. Some health I.T. vendors have business models that create real impediments to the sharing of medical information.”
Under a typical arrangement, Mr. Haley said, a vendor tells hospitals, “It will cost you $1 million to build a connection to another system, we will charge $500,000 a year to maintain that connection, and on top of that we’ll charge $2 each time we send a patient’s records to hospitals that use a different system.”
Congress took a first step to address the problem in a bill signed into law last month. It said that doctors and hospitals must not deliberately block the sharing of information if they receive federal bonus payments for using electronic health records.
A separate bill approved last week by a House committee defines “information blocking” as a federal offense. Doctors, hospitals and technology vendors could be punished with civil fines of up to $10,000 for each violation.
“Since 2009, we have spent $29 billion to encourage the adoption of electronic health records, but the data is still fragmented,” said Representative Michael C. Burgess, Republican of Texas. “Vendors continue to impede the exchange of information.”
Even within a hospital, communications can be a challenge.
William F. Barrow II, president of Our Lady of Lourdes Regional Medical Center in Lafayette, La., said his 186-bed hospital had two systems of electronic health records — one from the Cerner Corporation for inpatients, another from Epic for outpatients.
“It’s hard to get the two to work optimally together,” Mr. Barrow said.
Amalia R. Miller, an economist at the University of Virginia who has studied the industry, said: “Even when hospitals have the technological capability, they do not always share information with hospitals outside their system. If information is portable, patients can switch providers more easily, and that could hurt the business of some hospitals.”
Thus, Ms. Miller said, federal money meant to foster an interconnected web of health care providers may inadvertently have subsidized the creation of “information silos,” making it more difficult to share data and coordinate care for consumers.