I always thought the data belonged to the patient and the provider is the custodian. This is blocking pure and simple. No rational excuse. Everything else is BS.
When providers are run as a business rather than as health institutions they are reluctant to share data. Need to revise the business model for information to be properly shared. HIPAA tried but did not go far enough when it came to portability.
To my point below, $billions$ are spent because of this poll question being quite relevant.
Context and definitions are important with polls such as this one. While the poll question is succinct, there is detail important to this topic missing. Detail like describing the provider, Epic version alignment or lack of it, and the licensing model.
Some provider organizations (Health System/IDN) enable affiliated physicians/groups (provider) and "relationship" hospitals to use the provider organization's Epic environment. Those downstream provider users often have little control over data sharing. In limited control situations, providers may want to share patient data with other providers, but be unable to.
Most provider organizations and physicians want to improve the patient experience and outcomes. Competition, control, liability, fear, and resistance to change can impact this regulatory mandated change.
By now, anyone valuing the use of the HIStalk and reading this response already knows and can take what I've started with here, much further.
So, what are we going to do about this mandate to enable data sharing when there is still so much resistance to share and real technical challenges still exist like: lack of definitions, data sharing parameters that are meaningful beyond the basic demographics and dates of service?
In my decades of helping providers to transform how they use data to improve the health of the communities they serve, I have only seen one state (North Carolina) act cohesively to share data important to the early detection of symptoms, and one market of hospitals (Lincoln and Omaha) act together to enable their physicians to see and share acute care patient data for 3 of 5 hospitals in the market. There are further successes in the few RHIOs that survive doing the basics and in California where in certain markets, the CAPG provider groups have worked together with payers to share data well.
These are the exceptions here and there and I have met incredible people who want to solve these issues for a variety of reasons. In the Seattle market, there has existed a ray of hope for others to follow, but literally, these beacons are dimming.
Back to the poll question "my interpretation" - If two providers with equal access to a shared and open data Epic environment are not sharing patient data with others on the same system, are they guilty of information blocking? Yes. Now we need to address why and figure out how to address their concerns so the patient is served best by those wanting to enable their health to be better. Regulations are not the best answer.
Oh, and if this is solved in one market and then this gets replicated, it will mean at least 40% of us reading HIStalk will be looking for new jobs. Billions are spend on HIT/S because of this very timely poll question.
I am facing this dilemma on a daily basis, personally. I do not believe there is any malice with the Providers in the Healthcare Community as a whole, maybe, but, not what I believe. I think and am convinced after speaking with the Providers that I work with, they are not completely aware of the legal ramification's as well as the interoperative elements of Epic, Cerner and most important, PCP running their own smaller Patient Relationship and Health Management Systems.
If there is malice intent, yes, I believe this answer is a yes. I would not assume this though, until discussions with parties have been exhausted.
I'm approaching this as a "balance of probabilities" question, and not an absolute. If the providers are in the same area, then there is going to be patient overlap. Information sharing ought to be a priority under these conditions.
"Never ascribe to malice that which is adequately explained by incompetence".
I would suspect the encounters occurred in a sensitive dept, and I think that is kosher.
As a default we enable sharing of most records. However, there are exceptions in the 21st Century Cures act which allow information blocking in order to protect the confidentiality or safety of the patient or other individuals who might be mentioned in a note. Epic wisely built in functionality that allows our providers to exercise case by case discretion about whether or not to share information related to a particular encounter, either with the patient, their proxy, or with other provider organizations.