After two years of legislative wrangling, the House of Representatives is set to vote today on the 21st Century Cures Act bill including several health IT provisions designed to address the challenges of electronic health record usability, interoperability, and data blocking.

Speaking on the floor of the Senate yesterday in advance of today’s House vote, Sen. Lamar Alexander (R-Tenn.) praised the legislation’s $6.3 billion in appropriations to fund the Obama administration’s Cancer Moonshot ($1.8 billion), Brain Research through Advancing Innovative Neurotechnologies ($1.6 billion), and Precision Medicine Initiative ($1.4 billion). The bill seeks to speed the approval of new medicines and medical devices, among other provisions.

Alexander, chairman of the Senate health committee, also called out the 21st Century Cures bill’s efforts to improve health IT. Noting that the federal government has spent more than $30 billion on incentives to get providers to adopt electronic health records, he charged that EHR systems are a “mess” and desperately need fixing.

Sen. Lamar Alexander (R-Tenn.)
Sen. Lamar Alexander (R-Tenn.)

“Several portions of the bill focus on two critical areas where improvement is needed to better leverage health IT and EHRs to their full potential,” says Ben Moscovitch, manager of HIT at The Pew Charitable Trusts. “Those two areas are enhanced interoperability and improved usability and patient safety.”

To address EHR shortcomings, the bill up for vote in the House would:

  • Establish a grant program to create an unbiased reporting system to engage stakeholders and gather information about EHR usability, interoperability, and security to help providers better choose EHR products.
  • Expedite interoperability among EHRs by developing or supporting a voluntary model framework and common agreement for the secure exchange of health information to help foster bridging between networks by: creating a digital healthcare provider directory to facilitate exchange; and requiring HHS to defer to HIT standards developed in the private sector.
  • Combine and reform existing Health IT Policy and Standards Advisory Committees to create a more streamlined HIT Advisory Committee to specifically address issues related to interoperability, privacy, and security. The new HIT Advisory Committee will engage stakeholders to identify priorities for standards adoption.
  • Establish authority for the HHS Office of the Inspector General to investigate claims of information blocking and assign penalties for practices found to be interfering with the lawful sharing of EHRs.
  • Encourage the exchange of health information between registries and EHR systems, while adding developers of health IT to Patient Safety Organizations to help improve the safety of HIT products for patients.
  • Support the certification and development of patient-centered EHRs so that patients have better access to their secure and up-to-date health information; encourage the use of health information exchanges to promote patient access by educating providers on allowable sharing of patient health information; and require HHS to educate providers on allowable uses and sharing of patient health information and clarify misunderstandings that may be currently impeding lawful sharing.

Blair Childs, senior vice president of public affairs for Premier, a healthcare alliance of 3,750 hospitals and 130,000 other providers, says his organization “strongly supports” the 21st Century Cures Act such as the provisions for EHR interoperability.

“Setting interoperability standards, and requiring free and secure health IT exchange among disparate assets will improve patient care, reduce costs and unlock data silos in healthcare,” argues Childs. “We are hopeful that Congress moves forward with passing the 21st Century Cures Act during the current lame-duck session. These provisions represent essential ingredients in enabling providers to improve patient care across the continuum.”

Also See: Coalition backs interoperability measures in 21st Century Cures Act

The bill would also require the Government Accountability Office to carry out a review of patient access to health information, including barriers to access, complications providers experience when providing access; and methods patients may use for requesting their personal health information. In addition, the legislation would require the GAO to conduct a study on methods for securely matching patient records to the correct patient.

Moscovitch believes that patient matching in particular will go a long way towards “addressing an issue that is absolutely essential to the interoperability of EHRs.” He says he is encouraged by the fact that the bill calls on the GAO to submit a report on patient matching, including a review of ongoing efforts and a focus on various ways that a patient can be matched to their records held at multiple healthcare facilities.

“Today, approximately one in 10 patients are not matched to their record within a facility, and that number can reach as much as 50 percent when talking about patient matching across facilities,” according to Moscovitch.

A Senate GOP aide contends that the 21st Century Cures bill will pass both the House and Senate with overwhelming majorities given that it contains bipartisan proposals that have already passed the House or the Senate health committee. The legislation authorizes spending “billions on Precision Medicine, to fight cancer and Alzheimer’s and opioid abuse” and “addresses the nation’s mental health crisis” as well as “finally helping to fix Americans’ electronic health records,” said the aide, who added that a vote in the Senate on the House-passed bill could happen as early as the beginning of next week.

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