Senator Lamar Alexander (R-Tenn.), chairman of the Senate health committee, plans to come up with a legislative fix in 2016 for the widespread problems that providers are experiencing with electronic health record systems through the committee’s “Innovation” bill—companion legislation to the 21st Century Cures Act that the House passed earlier this year.

Alexander’s committee held six hearings in 2015 on a range of health IT topics including patient access to their health data, interoperability, EHR user experience and information blocking. In 2016, he intends to make HIT a legislative priority, taking steps to improve EHRs—a technology the senator believes has great promise but, through bad policy and incentives, has gotten off track.

“Number one, what we want to turn our attention to next is what we call our Innovation bill,” Alexander said Dec. 20 during an interview on C-SPAN. “We’ve been working for a year staff-wise on a whole variety of bipartisan ideas. I talked to (Ranking Member) Senator Murray this week. I hope that’s our next one.”

Also See: Senate Ready to Provide Legislative Fix to EHR Problems

Interoperability, in particular, has been a focus this year of the Senate health committee, which has been working with the Obama administration to develop areas of agreement for legislation to achieve interoperable health information exchange. Alexander has charged that many of the Meaningful Use program’s rules and requirements for EHRs are actually preventing these systems from being able to communicate with one another.

In addition, at Alexander’s request, earlier this year the Office of the National Coordinator for Health IT submitted a report to Congress on the problem of information blocking—the act of intentionally interfering with the sharing of data between doctors and hospitals. The report concluded that successful strategies to prevent information blocking by both providers and vendors would likely require congressional intervention.

For its part, the House’s 21st Century Cures Act includes several provisions designed to improve EHR interoperability seeking to “refocus national efforts on making systems interoperable and holding individuals responsible for blocking or otherwise inhibiting the flow of patient information throughout our healthcare system.” Specifically, the bill would impose financial penalties and decertification for “bad actors” engaging in information blocking.

According to Alexander, the Senate health committee has been working on a “parallel track” to produce a bill that can be combined with the 21st Century Cures Act. However, at this point, industry groups can only speculate as to what might be included in the committee’s legislation next year.

Joel White, executive director of Health IT Now, expects the Senate in its bill to include provisions of the TRUST IT Act introduced by Sens. Bill Cassidy, M.D. (R-La.) and Sheldon Whitehouse (D-R.I.) that would make health IT systems accountable for their performance in three key areas: security, usability, and interoperability. In particular, the bill seeks to establish a HIT rating system—to be published on ONC’s website—to enable consumers to compare certified products on those three criteria. It also requires vendors to report on the performance of their products every two years and authorizes the assessment of fines—and in some cases decertification of products—for failing to report.

But, Leigh Burchell, Electronic Health Records Association chair and vice president for policy and government affairs at software vendor Allscripts, notes that some of these punitive measures have been “questioned broadly” by a number of industry stakeholders and expects that there will be more of a focus on “industry transparency and less on penalties or prescriptive requirements” in the Senate.

“We also expect that there will be definitions included on some of the more important topics, such as information blocking, which we hope will build on the ideas included in the ONC’s report on the topic, including the important concept of ‘intent,’” says Burchell.

Perhaps, most significantly—given increasing calls from industry groups to delay the start of Stage 3 Meaningful Use until at least 2019—White says there is a chance Alexander’s committee could accommodate those requests.

Following the release of the final Stage 3 rule in October by the Centers for Medicare and Medicaid Services, Alexander said that it was a mistake for CMS to “rush ahead with a rule against the advice of some of the nation’s leading medical institutions and physicians.” As a result, he warned that Congress would “carefully review this rule and has the option of fixing it through legislation or overturning it through the Congressional Review Act” and that Stage 3 should be “phased in at a rate that reflects how successfully the program is being implemented.”


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