Source
2020 (fielded 2021) and 2022 American Hospital Association Health Information Technology Supplements.
Citation
Office of the National Coordinator for Health Information Technology. ‘Trends in Hospital Leaders’ Perceptions of Information Blocking’ Health IT Quick Stat #65
The applicability date of the information blocking regulations occurred in April 2021. The American Hospital Association Health Information Technology Supplement Survey fielded in 2021 and 2022 included questions on hospital leaders’ perceptions of practices that may constitute information blocking. While identification of whether a practice (an act or omission) constituted information blocking depends on the unique facts and circumstances of the practice, these data can provide a sense of the perception of key stakeholders. These findings are discussed in more detail in a blog post on the Health IT Buzz Blog.
Percent of Hospitals that Perceived Each Actor Engaged in Possible Information Blocking
| 2021 | 2022 | |
|---|---|---|
| Health Care Providers (n=4,239) | 36% | 12%* |
| State, regional, and/or local health information exchange (n=4,082) | 19% | 20% |
| Developers of Certified Health IT (e.g. Enterprise EHR vendors) (n=4,240) | 17% | 22%* |
| National Networks (n=3,955) | 7% | 6% |
| Any Actor (n=4,538) | 42% | 32%* |
| * denotes a statistically significant difference between 2022 and 2021 at p<0.05. Sample sizes correspond to the combined responses for 2021 and 2022. | ||
The survey also includes three questions on how healthcare providers engaged in practices that may be perceived as information blocking. Strategic affiliations, which are described as promoting alternative, proprietary approaches to information exchange or exchanging only within referral network or with preferred referral partners, was the most common type of practice in 2022.
Percent of Hospitals that Perceived Developers of Certified Health IT Engaged in Four Types of Possible Information Blocking
| 2021 | 2022 | |
|---|---|---|
| Artificial technical, process, or resource barriers (n=4,045) | 35% | 20%* |
| Refusal to exchange patient information (n=4,011) | 26% | 15%* |
| Strategic Affiliations (n=3,951) | 32% | 29% |
| * denotes a statistically significant difference between 2022 and 2021 at p<0.05. | ||
For additional insight into how some actors engage in practices that may be perceived as information blocking, the survey includes questions on four different specific types of practices by developers. In both years price was listed as the most common type of perceived information blocking by EHR developers (note that for consistency with prior surveys, this question asks specifically about EHR vendors).
Percent of Hospitals that Perceived Developers of Certified Health IT Engaged in Four Types of Possible Information Blocking
| 2021 | 2022 | |
|---|---|---|
| Price, including unreasonable fees (n=4,067) | 28% | 29% |
| Contract language to discourage exchange of patient information (n=4,069) | 20% | 23%* |
| Artificial technical, process, or resource barriers (n=3,999) | 19% | 19% |
| Refusal to exchange patient information (n=4,012) | 10% | 16%* |
| * denotes a statistically significant difference between 2022 and 2021 at p<0.05. | ||
Data are from the American Hospital Association (AHA) Information Technology (IT) Supplement to the AHA Annual Survey. Since 2008, ONC has partnered with the AHA to measure the adoption and use of health IT in U.S. hospitals.
The chief executive officer of each U.S. hospital was invited to participate in the survey regardless of AHA membership status. The person most knowledgeable about the hospital’s health IT (typically the chief information officer) was requested to provide the information via a mail survey or secure online site. Non-respondents received follow-up mailings and phone calls to encourage response.
This quick stat presents results from the 2020, and 2022 AHA IT Supplements. Due to pandemic-related delays, the 2020 survey was not fielded on time and was fielded from April 2021 to September 2021. Since the IT supplement survey instructed respondents to answer questions as of the day the survey is completed, we refer to responses to the 2020 IT supplement survey as measuring hospitals in 2021. The 2022 survey was fielded from July 2022 to December 2022.
The response rate for non-federal acute care hospitals was 50 percent in 2022 and 54 percent in 2022. Overall, 2,092 hospitals responded to the information blocking questions in 2021 and 2,446 responded in 2022. A logistic regression model was used to predict the propensity of survey response as a function of hospital characteristics, including size, ownership, teaching status, system membership, and availability of a cardiac intensive care unit, urban status, and region. Hospital-level weights were derived by the inverse of the predicted propensity.
In 2021, the survey included the question “To what extent have you observed the following stakeholders engaging in information blocking behaviors?” and asked about four actors, 1) Developers of Certified Health IT (e.g., Enterprise EHR vendors), 2, Healthcare Providers, 3) National Networks (e.g., CommonWell, eHealth Exchange) 4) State, regional, and/or local health information exchanges. The four actor types identified in the survey correspond to categories of actors defined in 45 CFR 171.102 for purposes of the information blocking regulations as follows: Those in the survey’s type (1) would likely fall into the health IT developer of certified health IT definition; those in type (2) would likely fall into the health care provider definition; and those in types (3) and (4) would likely fall into the health information network or health information exchange definition.
The 2022 Survey included the same question but did not ask about healthcare providers in that question set. Instead, a separate question asked, “To what extent have you observed healthcare providers engaging in information blocking behaviors?”
In both 2021 and 2022, the survey included two sets of questions on specific types of information blocking. The first question asked, “In what form(s) have you observed or experienced information blocking by Enterprise her vendor(s)?” and listed four types: 1) price; 2) contract language; 3) artificial technical, process or resource barriers; and 4) refusal, with additional examples of each. The survey further asked, “In what form(s) have you observed or experienced information blocking by healthcare providers?” and listed three types: 1) artificial technical, process or resource barriers; 2) Refusal; and 3) Strategic affiliations.
For all items above, Respondents could report Often/Routinely, Sometimes, Never/Rarely and Don’t know. For this quick stat, responses were dichotomized as either Often/Routine or Sometimes versus Never/Rarely, with hospitals reporting “Don’t Know” or not responding to that specific question omitted.