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This report responds to Congress’s request for the Office of the National Coordinator for Health Information Technology (ONC) to produce a report on the extent of health information blocking and a comprehensive strategy to address it. An examination of these issues is both timely and warranted. Since the enactment of the HITECH Act and subsequent legislation, the federal government has invested over $28 billion to accelerate the development and adoption of health information technology (health IT). The purpose of these efforts is to enable an interoperable learning health system—one in which electronic health information is available and can be securely and efficiently shared, when and where it is needed, to support patient-centered care, enhance health care quality and efficiency, and advance research and public health. While many stakeholders are committed to achieving this vision, current economic and market conditions create business incentives for some persons and entities to exercise control over electronic health information in ways that unreasonably limit its availability and use. Indeed, complaints and other evidence described in this report suggest that some persons and entities are interfering with the exchange or use of electronic health information in ways that frustrate the goals of the HITECH Act and undermine broader health care reforms. These concerns likely will become more pronounced as both expectations and the technological capabilities for electronic health information exchange continue to evolve and mature. As more fully defined in this report, information blocking occurs when persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information. This report provides principled and practical criteria for identifying such conduct and distinguishing it from other barriers to interoperability and health information exchange. It also examines the nature and extent of information blocking, based on available evidence and the accumulated industry knowledge and experience of ONC. While the evidence is in some respects limited, there is little doubt that information blocking is occurring and that it is interfering with the exchange of electronic health information. ONC believes that information blocking is best addressed through a combination of targeted actions aimed at deterring and remedying information blocking, and broader strategies and approaches that engage the larger context in which information blocking occurs. This report details actions that ONC is currently taking or has proposed to take, in coordination with the Department of Health and Human Services (HHS) and other federal agencies, to target and address information blocking. While important, these actions alone will not provide a complete solution to the information blocking problem. Indeed, a key finding of this report is that many types of information blocking are beyond the reach of current federal law and programs to address. Thus a comprehensive approach will require overcoming significant gaps in current knowledge, programs, and authorities that limit the ability of ONC and other federal agencies to effectively target, deter, and remedy this conduct, even though it frustrates the important public policy of enabling electronic health information to flow in support of patients and improvements in health and health care.
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