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Let my [information] go …

Information blocking impacts patient care every moment of the day. It once impacted my patient care (story at a later date); it affects your care, your family's care, and everyone’s care.
April 24, 2024

Raise your hand if you used cash to complete a purchase over $100 in the past month.

Uh-huh – that’s what I thought …very, very few of us.  In fact, I’ll wager 50% have not used cash this month.

The reason we don’t use cash is that the banking and financial systems provide a secure, convenient, and fast method to complete financial transactions

Each of us quickly adopts the growing aspects of the financial system (e.g. credit & debit cards, Venmo, et al) as well as more advanced ones (e.g. commodity trading, loan processing, etc.).

Cash is paper-based and we – as consumers – find it messy.  And it slows things down.

Now here’s the (not so big) leap into healthcare: patient information – when transferred between organizations – continues to be primarily paper-based (i.e. fax) or pre-packaged or untimely. Messy.

Do you see where I’m going here?  Of course, you do!

Yes, EHRs and interoperability and FIHR et al exist, but there remain high costs associated with enabling connectivity, as well as a low sense of urgency from the technology stakeholders.  (uhm, that will be $20,000 and 6 months until live).  It’s like how you feel when notified of a supplemental charge for an ATM withdrawal outside your banking network; it screams ‘penalty’.

What you may not see is just how darned close healthcare is to moving records in the similar secure, convenient, and fast methods as consumer financial transactions (i.e. a patient)

HHS knows it.  CMS (the largest US healthcare payer) knows it.  That’s why the Center for Medicare and Medicaid Innovation Center (CMMI) was established in 2010: to get things moving in healthcare.

Ok – enough history.  Let’s get to the point.

The point is … CMMI delivered some really cool stuff over the last 13 years and you deserve to know about – and adopt – the latest and greatest which impacts every one of us as a patient or a care provider.

Now this may sound like the beginning of a ‘patient’s rights’ speech.  It’s not.  But it could be, a bit.

Maybe it’s best for me to paraphrase comments made by Don Rucker MD when he was the HHS National Coordinator for Health Technology (2017 – 2021).  He told a group at a HIMSS conference a story that went like this … the patient is more than capable of participating in their delivery of care by having easy-to-use technology.  For example, today [he] traveled to this event by using three mobile apps: one to purchase and gain access to [his] flight, another to reserve and find [his] ride from the airport to the meeting, and the last to arrange where [he] will sleep tonight.

Fast forward to the present day.

On June 27, 2023, HHS-OIG posted its final rule implementing information-blocking penalties. The final rule establishes the statutory penalties created by the 21st Century Cures Act.

You may ask, “Why is it called information blocking?”  I asked the same.  Here’s my current answer: because health entities consider patient information as a strategic asset to their organization, not a strategic resource for the patient.

I prefer the law to call it ‘information enabling’ but I do tend to look at the glass as half full.

When the OIG (Office of the Inspector General) determines that an individual or entity has committed information blocking, they may be subject to up to a $1 million penalty per violation.

Let’s unpack these last lines and focus on some numbers:

First: more than 7 years ago HHS announced a long runway for “actors” (i.e. health exchanges, EHR vendors, health systems, providers, etc.) to not “interfere” with the sharing of patient data.  There’s been little improvement in seven years, so…

Next: last year’s final rule established penalties of up to $1 million per violation – for an individual or an entity that interferes.

Numbers catch my attention.  $1 million is a big violation.

A number like that likely catches your attention – as a patient, as a caregiver to a patient, as well as a healthcare professional.

Information blocking impacts patient care every moment of the day.  It once impacted my patient care (story at a later date); it affects your care, your family’s care, and everyone’s care.

And it contributes to a lot of waste in the delivery of patient care.

Information blocking is kind of like litter.  Most of us try not to be the cause of litter.  But what can we do to eliminate or address the litter caused by another?

Well, it turns out YOU, or any mere mortal can help eliminate information blocking.  The OIG established the ONC Information Blocking Portal for any person or entity to initiate an investigation.  Sorry, there’s no whistle-blower program.

As of this posting, in less than one year the ONC has received more than 1,000 complaints.  That’s more than three per day.

70% of the claims originate from patients or someone on their behalf.

The ONC determined that 93% of the claims are possibly information blocking and are under further investigation (i.e. only 7% failed the sniff test).

Pause here for a moment – did you know that you (as a patient or caregiver or a healthcare entity) could report a violation to the ONC about information blocking?

I get it … I get it … you likely cannot recognize if you even experienced information blocking.  It is sort of sneaky – like monitoring the other football team’s play calls or changing the air pressure in a football.  But, the providers and the insurers/payors who manage your care sure know when it happens.  And they are about to get mad as he**.

I encounter information blocking every day in my business dealings. Every day. My company endeavors to eliminate it. And I’m going to tell you what to watch for.

This is like a cicada hatch – we’ve been watching and waiting 7 years for The Cures Act to come into full effect.  And here it is.

I think it’s about to get very noisy.

Upcoming posts will cut through the noise to help each of us focus on advocating for ‘information enabling’ in our personal lives as well across the healthcare landscape.

Here’s a teaser about the next post: per the Federal Register “the law applies the standard of whether they [health exchange or EHR vendor] know, or should know, that a practice is likely to interfere with the access, exchange, or use of EHI. For healthcare providers, the law applies the standard of whether they know that the practice is unreasonable and is likely to interfere with the access, exchange, or use of EHI.”

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AndrewRittler - Chief Executive Officer

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Andrew Rittler

Andrew Rittler, Chief Executive Officer, joined MITEM Corporation in 2013 to bring the eVigils platform to market and lead product direction. Andrew has a 35-year history in healthcare technology leading consulting, sales, and service operations.

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