EHR Decertification in 21st Century Cures Act Raises Concerns

The latest draft of the 21st Century Cures Act, forwarded to the House Energy and Commerce Committee for consideration next week, includes language to advance health IT interoperability by decertifying electronic health records products that block information sharing.

Among other provisions, the bill directs the Office of the National Coordinator for Health IT to certify only EHR products that meet meaningful use program standards and that do not block health information exchange.  Conversely, starting Jan. 1, 2019, the proposed legislation states that ONC should take steps to decertify EHR products that block sharing.

Also See: Info Blocking Gains Prominence as Interoperability Challenge

“The provision in today’s bill seeks to give the Office of the National Coordinator additional tools to set standards and metrics to hold software vendors accountable, but we need to make sure that we set this up in a way that works,” said Rep. Doris Matsui (D-Calif.) at a May 14 health subcommittee markup of the bill, emphasizing that the proposed legislation is in draft form and “we still need to work to get it right.”

Likewise, Rep. Frank Pallone (D-N.J.), ranking member on the House Energy and Commerce Committee, cautioned that “this is a very complicated policy and I hope we take all the necessary time to ensure we get that policy right.”

“If systems don’t talk, we’ll never achieve the patient-centered care that we’re striving for and we’ll still end up with duplicate testing and lack of integration,” added Matsui. “We need to make sure those systems work for our providers and patients—that providers have access to data for population health management and that patients have access to their own data to be fully engaged in their own care.”

While the Health Information Management and Systems Society agreed that “appropriate exchange of health information is a key underpinning of healthcare transformation,” the organization issued a statement voicing its concern that the policies included in the 21st Century Cures Act “may be overly complex, exclude critical stakeholders, and may cause inhibiting disruptions in the marketplace.”

Similarly, Jodi Daniel, director of ONC’s Office of Policy, argues that congressionally-mandated product decertification could negatively impact the healthcare industry as a whole. Specifically, Daniel cautioned that decertifying EHR products is a “blunt instrument” that could have negative effects on providers.

“If we decertify a product that a lot of providers are using, then the providers don’t have a certified product and either they have to switch products or they will fall out of compliance with Meaningful Use,” she said. “It might penalize the bad action by a vendor, but it will cause harm to innocent providers.”