{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T03:09:56Z","timestamp":1775704196097,"version":"3.50.1"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2021,1,7]],"date-time":"2021-01-07T00:00:00Z","timestamp":1609977600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["5K12HS026395-02"],"award-info":[{"award-number":["5K12HS026395-02"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"AHRQ","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000016","name":"US Department of Health and Human Services","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"crossref"}]},{"name":"National Coordinator for Health IT","award":["HHSP233201700049C"],"award-info":[{"award-number":["HHSP233201700049C"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Recent policy making aims to prevent health systems, lectronic health record (EHR) vendors, and others from blocking the electronic sharing of patient data necessary for clinical care. We sought to assess the prevalence of information blocking prior to enforcement of these rules.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>We conducted a national survey of health information exchange organizations (HIEs) to measure the prevalence of information blocking behaviors observed by these third-party entities. Eighty-nine of 106 HIEs (84%) meeting the inclusion criteria responded.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The majority (55%) of HIEs reported that EHR vendors at least sometimes engage in information blocking, while 30% of HIEs reported the same for health systems. The most common type of information blocking behavior EHR vendors engaged in was setting unreasonably high prices, which 42% of HIEs reported routinely observing. The most common type of information blocking behavior health systems engaged in was refusing to share information, which 14% of HIEs reported routinely observing. Reported levels of vendor information blocking was correlated with regional competition among vendors and information blocking was concentrated in some geographic regions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Our findings are consistent with early reports, revealing persistently high levels of information blocking and important variation by actor, type of behavior, and geography. These trends reflect the observations and experiences of HIEs and their potential biases. Nevertheless, these data serve as a baseline against which to measure the impact of new regulations and to inform policy makers about the most common types of information blocking behaviors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Enforcement aimed at reducing information blocking should consider variation in prevalence and how to most effectively target efforts.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocaa323","type":"journal-article","created":{"date-parts":[[2020,12,10]],"date-time":"2020-12-10T03:32:06Z","timestamp":1607571126000},"page":"727-732","source":"Crossref","is-referenced-by-count":44,"title":["Information blocking remains prevalent at the start of 21st Century Cures Act: results from a survey of health information exchange organizations"],"prefix":"10.1093","volume":"28","author":[{"given":"Jordan","family":"Everson","sequence":"first","affiliation":[{"name":"Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA"},{"name":"Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA"}]},{"given":"Vaishali","family":"Patel","sequence":"additional","affiliation":[{"name":"Data Analysis Branch, Office of the National Coordinator for Health Information Technology, Washington, DC, USA"}]},{"given":"Julia","family":"Adler-Milstein","sequence":"additional","affiliation":[{"name":"Department of Medicine, UCSF School of Medicine, San Francisco, California, USA"}]}],"member":"286","published-online":{"date-parts":[[2021,1,7]]},"reference":[{"issue":"5","key":"2021031906034866300_ocaa323-B1","doi-asserted-by":"crossref","first-page":"3285","DOI":"10.1111\/1475-6773.12838","article-title":"Technology, incentives, or both? Factors related to level of hospital health information exchange","volume":"53","author":"Lin","year":"2018","journal-title":"Health Serv Res"},{"key":"2021031906034866300_ocaa323-B2","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.jhealeco.2013.10.004","article-title":"Health information exchange, system size and information silos","volume":"33","author":"Miller","year":"2014","journal-title":"J Health Econ"},{"issue":"1","key":"2021031906034866300_ocaa323-B3","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1111\/1475-6773.13240","article-title":"Sharing information electronically with other hospitals is associated with increased sharing of patients","volume":"55","author":"Everson","year":"2020","journal-title":"Health Serv Res"},{"issue":"3","key":"2021031906034866300_ocaa323-B4","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1136\/jamia.2010.003673","article-title":"Health information exchange: persistent challenges and new strategies","volume":"17","author":"Vest","year":"2010","journal-title":"J Am Med Inform Assoc"},{"issue":"2","key":"2021031906034866300_ocaa323-B5","first-page":"66","article-title":"The total cost of EHR ownership: healthcare organizations should consider support costs, upgrade fees, and other long-term costs of EHR systems in determining the total cost of ownership","volume":"67","author":"Eastaugh","year":"2013","journal-title":"Healthc Financ Manage"},{"key":"2021031906034866300_ocaa323-B6","year":"2015"},{"issue":"7","key":"2021031906034866300_ocaa323-B7","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1377\/hlthaff.2015.1215","article-title":"Engagement in hospital health information exchange is associated with vendor marketplace dominance","volume":"35","author":"Everson","year":"2016","journal-title":"Health Aff"},{"key":"2021031906034866300_ocaa323-B8","year":"2016"},{"issue":"1","key":"2021031906034866300_ocaa323-B9","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1111\/1468-0009.12247","article-title":"Information blocking: is it occurring and what policy strategies can address it?","volume":"95","author":"Adler-Milstein","year":"2017","journal-title":"Milbank Q"},{"key":"2021031906034866300_ocaa323-B10","volume-title":"ONC Data Brief, No.51","author":"Pylypchuk","year":"2020"},{"key":"2021031906034866300_ocaa323-B11","year":"2020"},{"issue":"7","key":"2021031906034866300_ocaa323-B12","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1377\/hlthaff.2015.1439","article-title":"The number of health information exchange efforts is declining, leaving the viability of broad clinical data exchange uncertain","volume":"35","author":"Adler-Milstein","year":"2016","journal-title":"Health Aff"},{"issue":"1","key":"2021031906034866300_ocaa323-B13","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.jamcollsurg.2010.09.014","article-title":"Cost of inpatient care and its association with hospital competition","volume":"212","author":"Chang","year":"2011","journal-title":"J Am Coll Surg"},{"issue":"1","key":"2021031906034866300_ocaa323-B14","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s11151-004-6067-7","article-title":"Do different measures of hospital competition matter in empirical investigations of hospital behavior","volume":"26","author":"Wong","year":"2005","journal-title":"Rev Ind Organ"},{"issue":"5","key":"2021031906034866300_ocaa323-B15","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1177\/0033354918791544","article-title":"Health information blocking: responses under the 21st Century Cures Act","volume":"133","author":"Black","year":"2018","journal-title":"Public Health Rep"},{"key":"2021031906034866300_ocaa323-B16","year":"2020"},{"issue":"6","key":"2021031906034866300_ocaa323-B17","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1093\/jamia\/ocx135","article-title":"Are all certified EHRs created equal? 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