As Congress considers delaying Meaningful Use Stage 3, a coalition of health IT groups and vendors seeks legislative changes to address the lack of interoperability. And they have 10 ideas for doing so.
Nine stakeholders—including Apervita, athenahealth, Health IT Now, Intel, National Alliance on Mental Illness, New Directions Technology Consulting, Oracle, United Spinal Association, and Verizon—have sent a letter to congressional leaders arguing that Stage 3 requirements are counterproductive to achieving interoperability.
“We write to urge you to oppose any legislative changes to the Meaningful Use program, including delays in the timing of Stage 3, that do not also include reforms to improve the interoperable use of health information technology,” states the Dec. 7 letter. “Delay without reform would rob taxpayers and patients of cost savings while doing absolutely nothing to make the program work well for overburdened doctors and hospitals.”
Since the Centers for Medicare and Medicaid Services issued its final Stage 3 rule in October, there has been a growing chorus of stakeholder groups pushing Congress to delay the final stage of Meaningful Use. Last month, an American Medical Association-led coalition of 111 medical societies sent a letter to congressional leaders requesting that lawmakers halt Stage 3 until Stage 2 can be significantly reformed.
In its December 7 letter, the nine organizations said they agree with national and state medical associations that Meaningful Use has failed to focus on interoperability and has instead created new barriers to health information exchange.
“Patients today have no guarantee that their health information will be accessible by their attending physician,” states the group. “Vendors are spending so much time reacting to numerous, and sometimes conflicting, government regulations on or related to the program that they have little time to improve their products based upon their customers’ needs. Information blocking has been confirmed by ONC as a problem in the program, and yet no enforcement action is taken against bad actors. Worse, medical providers face financial penalties for using products that are not interoperable, while the government continues to subsidize these products.”
To fix these problems, the group recommends a number of congressional measures, including:
Definition of interoperability. Support establishing a common definition of interoperability in statute.
Information blocking. Support once and for all ending information blocking in a taxpayer-funded program that is intended to exchange information.
Standards. Support adoption of industry-developed standards based upon reference implementation models, promotion of open APIs, and thorough interoperability testing as a condition of certification.
Certification. Congress should provide incentives to vendors to continuously improve their products. The group suggests basing full certification of products on performance of those products on key measures of interoperability and usability.
Testing. The National Institute of Standards and Technology should be charged with testing the interoperability of products in test beds while Authorized Certification Bodies should be required to conduct in the field surveillance to test whether products conform to the standards established in the program.
EHR Marketplaces. Physicians should have access to all relevant data about an EHR before deciding to use one in practice, including data on certification, decertification, penalties, and information blocking incidents in a way that is usable and easily accessible to stakeholders.
Reporting problems. Congress should require HHS to establish a process and online tool for providers and patients to report instances when the provider’s EHR is unable or fails to transmit or receive patient information with another provider or when a patient is unable to transmit or receive information from their provider.
Enforcement. Support applying civil monetary penalties and decertification—program exclusion—for bad actors, including those who engage in information blocking. Congress should also enact additional protections for providers’ whose products are decertified or who are forced to switch products due to unfair business practices engaged in by vendor companies, such as information blocking. Congress should require CMS to provide all providers whose product has been decertified with a hardship exemption, establish a hardship fund to aid providers with this transition, as well as make it easier for providers to get access to the full suite of data contained in their EHRs in an interoperable format to facilitate their transition to a new vendor.
Penalty structure. Support allowing HHS to charge penalties against vendor companies for bad actions, such as not adhering to interoperability standards or information blocking, and use those penalties to assist providers whose EHR systems have been decertified.
Operational Efficiencies. ONC should not manage grant programs as it is not in their core set of competencies and it detracts from what should be their primary focus—achieving interoperability across systems and providers. We suggest transferring grant authority to an alternative agency with experience and dedicated staff capable of administering funding programs.
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