Senate Committee Targets EHR Improvements, HIE

The Senate Health, Education, Labor, and Pensions Committee is continuing its crusade to identify ways that Congress and the Obama administration can collaborate to improve electronic health records and create industry-wide interoperability.

At a June 10 hearing, Sen. Lamar Alexander (R-Tenn.), chairman of the Senate committee, said the goal is to “identify the five or six steps that we can take working with the administration to improve electronic health records—a technology that has great promise, but through bad policy and bad incentives has run off track.” In Alexander’s opinion, the best way to solve current EHR challenges is for industry to “do it itself” and secondarily to have federal policy address these issues. But, as a backup plan, he said Congress “might have to pass a law.” 

By working with providers and the Obama administration, Alexander advocated that EHRs can be brought “back on track” to “make it a tool that hospitals and physicians can look forward to using to help their patients instead of something they dread.” He lamented the fact that doctors are “spending more time taking notes than taking care of patients, and they are spending a lot of their own money on systems that have to comply with government requirements.” In addition, ranking member Sen. Patty Murray (D-Wash.) told the committee that “many physicians across the country are facing a Medicare payment reduction this year because they are struggling to meet requirements for the use of electronic health records.”

According to Alexander, all hospitals and most physicians that tried were able to meet Stage 1 meaningful use requirements. However, he charged that Stage 2 MU requirements are “so complex that only about 11 percent of eligible physicians have been able to comply so far, and just about 42 percent of eligible hospitals.”

Thomas Payne, M.D., medical director of IT Services at the University of Washington School of Medicine and chair-elect of the American Medical Informatics Association (AMIA) Board of Directors, told Alexander that the Centers for Medicare and Medicaid Services should delay Stage 3 “until it’s improved.”

However, Christine Bechtel, president of Bechtel Health and chair of the Health IT Policy Committee’s Consumer Work Group, warned the committee that by delaying Stage 3 “there are aspects of patient engagement that we would give up if we delayed Stage 3 wholesale” including “requiring a greater percentage of doctors to share information electronically not just with patients but other doctors” as well as “lose a technical fix” in the form of application programming interfaces “that would help us to unlock the data that is currently siloed in patient portals.”

Nonetheless, Payne referenced AMIA’s recently released EHR-2020 Task Force report and its 10 recommendations for creating a person-centric, learning health system over the next five years. “The simple message resonating among the Tasks Force’s recommendations: slow down regulation to accelerate progress,” he said. “Ensuring CMS does not rush to get to the next stage of meaningful use, but rather works to help the private sector accelerate optimization of the tools and regulations that are already in place; and reorienting ONC’s certification program to test true interoperability by testing how systems both send and receive information are among the key steps HHS should take in the near-term. Should the regulatory pressure continue, stakeholders may look to Congress to intervene.”

Also See: AMIA Tackles EHR Adoption Challenges

Payne told the Senate committee that Congress “would engender genuine and lasting impact by enabling all patients to have their medical record, not just a summary of their record, available in standardized, machine-readable formats,” adding that “it is unconscionable that in 2015, with the widespread adoption of electronic health records, a patient must still print and scan their medical record when they change to a new physician.”

Likewise, Bechtel envisions a future in which patients no longer must use the “sneaker net”—where they physically walk their medical records around to different doctors—and instead “leverage the Internet to drive quality, value and patient-centered care.”

Craig Richardville, chief information officer of the Carolinas HealthCare System and chair of the Premier healthcare alliance’s Member Technology Improvement Committee, testified that “improving health information exchange and achieving true interoperability is one of the key challenges of our time.” To achieve interoperability, he recommended a “combination of congressional leadership and administrative actions that promote policy principles that further open health IT infrastructures.”

Richardville noted that industry efforts to remove the barriers to interoperability—such as the Argonaut Project, Carequality, and CommonWell—are making progress, but he advised that the federal government needs to help define what the rules of the road are so these organizations can all abide by the same rules.

Bechtel told the senators that the U.S. healthcare system is “struggling to foster the kind of exchange that will drive better care and smarter spending.” The problem, Bechtel said, is that many healthcare organizations “still treat health data as a close-hold business asset, when it should be treated as a public good.”

Neal Patterson, CEO of Cerner Corporation, called healthcare organizations’ blocking of the flow of information that could help individuals—and their providers—make better-informed decisions about their care immoral. “Healthcare is too important not to change,” Patterson argued.

As an EHR vendor, he took partial responsibility for the lack of interoperability plaguing health IT. “The electronic health record community has grown up alongside each other—Meditech, Cerner, Epic, McKesson, Allscripts and many others,” Patterson said in his testimony. “We were out conquering the map. Each of us has had our own version of building our core capabilities. Competition has been healthy, and it has driven a lot of innovation. But too often these competitive instincts led to technological silos.”

Patterson asserted that vendors and providers alike “must enable sufficient transparency around data sharing to allow keeping a watchful eye on behaviors in our industry” and that if necessary Congress should take action against these bad actors. “Whether intentional or unintentional, behaviors that restrict patient choice, throw up roadblocks to true interoperability, or use control over data to further market share should be challenged. None of us have a perfect record, and we can all do better.”

The head of Cerner asserted that health IT platforms must be open and interoperable. “Getting to full interoperability requires active cooperation among all the vendors, and their acceptance that once technological silos are eliminated, they will have to compete on innovation, quality and cost,” Patterson added. “We do not have this yet in health IT, but this kind of dialogue at the national level has a chance of creating real change.”

The committee will hold a follow-up hearing on June 16, focusing on the burdens that physicians face using EHRs.

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