US Gov’t Report Says Health IT Infrastructure Impedes Competition

December 05, 2018 - Health IT infrastructure often facilitates anticompetitive practices in healthcare, such as blocking clinical information exchange between providers or not supporting regional information sharing, according to a report released this week by HHS and the Departments of Treasury and Labor.

At the root of this anticompetitive impact is the lack of interoperability among health IT systems, which hampers patient mobility and stymies competition among providers, judged the report, Reforming America’s Healthcare System Through Choice and Competition.  

The report identified a number of barriers to health IT interoperability.

First, medical complexity means that a diagnosis, treatment, or procedure in medical records can be recorded in many ways. This lack of standardization makes it difficult to share information among providers and other healthcare organizations.

Second, the healthcare industry’s fee-for-service model, where organizations bill patients or payers for each service, discourages sharing of information. Rather, providers maximize their revenue by ordering their own medical images and lab tests, rather than using results gathered by another provider.

“The fee-for-service model provides little incentive to connect with other clinicians or service providers and leads to significant disconnects across the care continuum, including among long-term and post-acute care facilities, outpatient services and support providers, behavioral health providers, free-standing imaging centers, and emergency medical services,” the report observed.

The government agencies noted that large health systems are acquiring smaller systems and practices and then limiting communication outside their network, creating barriers to entry and stifling provider competition. 

Third, there is a lack of accessible application programming interfaces (APIs) for electronic health records (EHRs). EHR developers often don’t publish their APIs, charge high fees for them, or set burdensome contract terms to use the APIs, the report charged. This inhibits new market entrants and new business models.

Fourth, most healthcare networks don’t or can’t communicate with one another. In fact, there are more than 100 regional and state health information networks, and many of them are incapable of sharing data.

“Typically, today’s health information networks prohibit flow of information to non-providers who may also have important HIPAA-compliant interests in that data, specifically insurers paying for those services,” the report observed.

The agencies noted that the 21st Century Cures Act has provisions designed to break down health IT barriers and improve interoperability.

First, the act prohibits information blocking, the practice of providers blocking access to an individual’s health data. The Office of the National Coordinator for Health Information Technology (ONC) is working on a narrow set of exceptions to this prohibition to address privacy, security, and patient care concerns.

Second, the act requires the establishment of a Trusted Exchange Framework and Common Agreement to encourage health information networks to share data. ONC is currently developing the framework and agreement.

Third, the act requires EHR app developers to publish open APIs to enable health information from those apps to be accessed, exchanged, and used without special effort. “The ‘without special effort’ provision means the API must use modern industry software design and healthcare interoperability standards,” the report explained.

The agencies recommended that the following steps be taken to improve health IT infrastructure access and interoperability.

• The administration should expeditiously implement provisions of 21st Century Cures Act to prevent information blocking, make it easier for patients to get their core health information, support open APIs to allow patients to get data on their smartphones, and support population-level data queries to allow payers electronic access to clinical data.
• Th Centers for Medicare and Medicaid Services (CMS) and ONC should continue work on reducing documentation burden to allow EHRs to provide informative medical records rather than boilerplate text for providers and patients.
• CMS should continue its emphasis on fostering interoperability across the healthcare sector and its efforts to make data available to patients through MyHealthEData and Blue Button 2.0.
• ONC should continue making standards more comprehensive and robust.

“Increasing competition and innovation in the healthcare sector will reduce costs and increase quality of care—improving the lives of Americans,” the report concluded.