‘Information blocking’ is a shameful practice in the electronic health record industry

Not many people can say they have a perfect marriage. I have two: one with my wife, Donna, and the other with the affiliated group of physicians I work with. I’m in both of these for the long haul, though some electronic mischief is threatening the latter.

Since I began practicing medicine, I have worked as an independent — but affiliated — pediatrician. Like so many independent physicians across the US, I had trouble going it alone. The administrative demands were too many, the industry and government changes too complex. Nearly two decades ago, in an effort to maintain my independence and stay in the green, I shifted from my first group and became affiliated with a larger local organization so I could partake in the shared resources and knowledge base of other practices.

Insights from the consulting company Accenture make me realize I’m not alone in the struggle to stay independent — the number of physicians who remain independent is steadily dipping, from 57 percent in 2000 to 33 percent last year.

There are many reasons that independents like me become affiliated with other physicians in their region, such as the benefits of clinical collaboration and increased power when it comes to patient referrals and payer negotiation. In many ways, this affiliation has helped me have the 30-year career I’ve wanted. It has let me maintain my independence and helped me remain profitable enough so I can carve out appointment space to serve the highly in-need Medicaid population. These appointments are rewarding for me and are clearly helpful for a population in need of affordable care.

As with all good relationships, there are bumps in the road. The one I now face is completely unacceptable and a huge distraction to me. I’d wager many other doctors across the country have the same problem.

Here’s the scenario. I went digital 11 years ago and embraced an electronic health record. In addition to storing vital information about my patients, this technology let me revamp the revenue cycle management of patient payments, share patient data, and more. I bought into the promise of improved efficiency, enhanced connectedness, and even a better experience that comes with most technology, and was happy with my decision. While things aren’t perfect, they’re very good.

Yet now I’m being told by the managers of my affiliated group that I and all of the other physicians in the affiliated group must adopt and use the same new electronic health record platform.

That doesn’t make sense to me. I have an iPhone and my neighbor has an Android, but we can still communicate. My bank account is with TD Bank and I regularly get my money from Citizens Bank ATMs; communication seems to be working there. Why in 2017 must all doctors be on the same system to communicate and share information?

A study I stumbled upon offers a somewhat sinister explanation. A pair of researchers at the University of Michigan Schools of Information and Public Health explored the practice known as information blocking. Their study confirms the very thing I’m suspecting: Some providers and vendors “knowingly interfere with the electronic exchange of patient health information.” According to the researchers, the most common form of information blocking is when hospitals and health systems, motivated by increased revenue and better position within the market, coerce providers to adopt a certain electronic health record or electronic health information exchange technology rather than simply make it possible to collaborate across these technologies.

It’s a shame that health care technology is being manipulated to protect and defend market share instead of being tweaked to enable connectedness across all care sites.

Between billing, compliance, safety, government mandates, referral patterns, and care coordination, the health care industry is enormously complex, particularly for independent doctors. As an industry, we need to activate our technologies to heal — not to hinder and distract providers. Even with more than 86 percent of doctors using electronic health records, connectivity between patients, providers, and payers remains complicated and largely elusive. It should be easier.

Sunlight is a highly effective disinfectant. I hope that this article, and the one by the Michigan researchers, will shine some light on a broken system. The companies that sell electronic health records and the organizations that buy them need to find ways to integrate and communicate with existing platforms, rather than quash them. That way we can create systems that work together to provide records that seamlessly follow our patients through their lifetimes and that helps doctors do their jobs.

Peter Masucci, MD, is a pediatrician in Everett, Mass.