Full implementation of the 21st Century Cures Act to accelerate medical breakthroughs could be in jeopardy if proposed budget cuts to the Office of the National Coordinator for Health Information Technology are not restored, according to the Pew Charitable Trusts and the American Medical Informatics Association.

A December 15 letter from the organizations to four congressional leaders warns that proposed budget cuts planned for ONC will hamper its efforts to implement the Cures Act.

The House of Representatives budget proposal calls for a $22 million cut in funds to ONC in Fiscal Year 2018 from $60.3 million in FY 2017, and the Senate proposal calls for a continuation budget next year of $60.3 million, said the letter, signed by Ben Moscovitch, manager of health information technology at Pew and Jeffrey Smith, vice president for public policy at AMIA.

The letter was addressed to Senators Roy Blunt and Patty Murray, and Representatives Tom Cole and Rosa DeLauro, who all hold powerful positions overseeing Labor, Health and Human Services and Education budgets.

Ben Moscovitch, Pew Charitable Trusts
Ben Moscovitch, Pew Charitable Trusts

Recent testimony from ONC Deputy National Coordinator Jon White indicated that the agency would not be able to fully fund bipartisan provisions in the Cures Act, including initiatives to improve the transparency, interoperability and usability of electronic health records, Moscovitch and Smith note in their joint letter.

However, efforts are ongoing to educate lawmakers on the frustrations that physicians face when working with EHRs, Moscovitch says. The challenges of interoperability and usability can bring safety concerns, he notes.

For example, a physician may order a medication for the wrong patient, notice and cancel the medication, and then re-enter the medication for the correct patient. But a safety problem could occur if the error was not noticed because of usability issues.

The industry needs ways to improve safety via better design of products, how they are implemented and customized, and how users work with the EHR, and developers need to be working alongside providers to determine and deploy improvements, Moscovitch adds.

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The Cures Act established an EHR reporting program requiring developers to submit data on the functionality of their products with the goal of helping providers assess the degree to which their EHRs can exchange data with other entities, along with usability and safety factors such as supporting care coordination, as well as the amount of time it takes clinicians to order medications, and whether the correct drug is being prescribed.

“The EHR reporting program is also an important component of another provision from Cures that establishes new conditions of certification for EHRs,” according to the letter to lawmakers.

“To meet these new conditions of certifications, EHR vendors must address a series of criteria, including not restricting communication on their product’s performance, attesting to real world testing and submitting data related to the EHR reporting program. As a result, the conditions of certification established in Cures can also not be met until the reporting program is established.”

Through the reporting program, developers and providers will gain insights to inform development, purchasing, implementing and customization of products.

Consequently, $15 million is authorized under Cures to implement the EHR reporting program. However, ONC’s Jon White has told House and Senate committees that “under the current budget proposal, “we are expecting to meet all the requirements of the Cures Act with the exception of the EHR reporting program.”

The top priority, Moscovitch says, is to ensure that ONC has the resources to implement reporting and usability measures that ensure that safety is addressed as a critical aspect of usability. The complete letter is available here.

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