Data blocking: pernicious evil or random personal preference?
Sending our two young sons to bed without dinner because they were fighting, even after a serious warning - is that appropriate discipline that engenders accountability and creates responsible, kind adults? Or is it a ploy to save money, guarantee a quiet adult evening, enjoy all the food for ourselves, and/or abuse our children? It may be a stretch, but this parenting example seems similar to the outcry about data blocking, hoarding, and a self-serving unwillingness to share data and related proposals on how to penalize offenders.
The 2015 interoperability questionnaire encouraged providers to clarify any unwillingness to share. When isolated, there are many reasons for data blocking. Participants made it clear that they don't see their vendors hoarding data or inhibiting the sharing of patient records. Hoarding is willingly refusing to share data. Providers overwhelmingly report that their vendors want to share, but business revenue models and a lack of technical resources often get in the way. Buyers see that the competitive nature of the U.S. market forces vendors to meet or exceed their competitors' sharing capabilities.
The irony of the accusations against vendors is apparent when we look at the willingness of providers to share with each other, especially their competitors. 98% of providers declare they are willing to share, while only 82% report that their main competitor is similarly willing. The bottom line: 18% of participants think their competitor is data blocking and is not willing to share. At least one solution supersedes a provider's ability to block the sharing of data. One CareEverywhere client, a physician who also serves as an executive, described the experience with CareEverywhere: I smile when I treat a patient from outside our organization and I can easily pull in his or her full fidelity record. Our competitor is on Epic, and despite our CEO's desire to keep us isolated, there is a lot of clinical information flowing back and forth. In fact, we measure daily the number of records moving back and forth between our competitor and us. That is a big deal. It's worth noting that the increase in capability and adoption around CommonWell and the Carequality interoperability framework (The Sequoia Project) appears to be heading toward unrestrained sharing, and the 2016 interoperability study should add clarity. It is worth noting that a majority of providers do not expect efforts such as CommonWell or the Sequoia Project to, by themselves, bring significant value to future interoperability, but energy is growing.
Sadly, small physician practices are those being penalized most for data blocking and are creating the biggest sharing hurdles. A typical smaller practice loves to get patient records (e.g. lab results, radiology results, TOC documents, etc.) but is much less likely to invest in pushing important patient clinical data out to the other caregivers of their patients. A lack of resources (time, money, and technical skills) typically stands in the way of proactively sharing. The effects of this two-edged sword can be expanded as we consider where the government and others with an interest will find (and they will) data blocking, hoarding, and an unwillingness to share and as we consider what these groups will decide can be done about those issues. The key is finding a common perpetrator to redirect so that patient records flow for better care. What if, until more effective connections are available through the collaboration, participants using CommonWell or Carequality opt to delay connections that would have immediate benefits to patient care but would consume time, custom efforts, and other resources? Is that data blocking?
So what happened with those two boys that went to bed early without dinner? One, Bruce, became an engineering professor at the University of Utah, the other is Adam, President of KLAS. Will the outcome be as positive when the government looks to force accountability with penalties for data blocking? Penalties will truly be a two-edged sword. Can the marketplace self-police? We shall see.