The senators, all Republicans, called out five “key implementation deficiencies” in the federal approach: a lack of a clear path toward interoperability; concerns about health IT increasing healthcare costs and not helping to control costs as previously estimated; a general lack of HIT program oversight; patient privacy and security risks; and concerns about whether providers can afford to maintain their federally incentivized healthcare technology long term.
The TMA, in a letter signed by Dr. Joseph Schneider, chairman of the TMA's ad hoc committee on health information technology, noted that before interoperability can happen, providers must have EHRs to interoperate with, noting that the EHR incentive payment program under the American Recovery and Reinvestment Act was “much-needed.” It helped increase the ranks of Texas physicians using EHRs from “only 25%” in 2005 to 60% in 2012 “with another 22% planning to adopt in the next two years,” according to a TMA survey. “This is significant growth in a short time,” according to the letter.
But the TMA also said that even when physicians are armed with EHRs, interoperability remains “extremely difficult,” and only a few health information exchange organizations can perform query-and-response exchange of healthcare information. To achieve complete data exchange capabilities quickly, “CMS and ONC should require EHR vendors to tag all EHR data elements with standardized XML and store it in their native tables,” which is done on a limited scale by Continuity of Care Document/Continuity of Care Record protocols.
HIMSS argued that the federal EHR incentive program “is definitely and positively affecting EHR adoption in this country,” citing data from HIMSS Analytics that indicate “U.S. hospitals are moving in the right direction to support information sharing necessary for care coordination that supports healthcare transformation.”
One of the “largest unresolved issues” toward interoperability that HIMSS cited was the need for “a nationwide patient data matching strategy,” noting that “does not mean a national identity number or card.”
“Technological advances now allow for much more sophisticated solutions to patient identity and privacy controls, including patient consent, voluntary patient identifiers, metadata identification tagging and access credentialing,” according to HIMSS' letter.
The organization also addressed whether misuse of EHRs may actually increase healthcare costs. It noted that providers have “always worried about claims fraud” and many report defensive “undercoding.” But among the other benefits of EHRs, “today's systems can facilitate better documentation.” Implied was that by documenting more thoroughly, physicians may be coding more accurately, and not leaving money on the table.
HIMSS' letter was co-signed by Willa Fields, chairwoman of its board of directors, a professor in the School of Nursing at San Diego State University; and HIMSS President and CEO H. Stephen Lieber.
The EHR Association, in its letter, stated that the Stage 1 criteria of the EHR incentive program “established an important foundation for interoperability,” which Stage 2 “substantially accelerates this progress through increased rigor in standards, certification criteria, and meaningful-use measures for clinical summaries, vocabularies and data transport across providers and EHRs at transitions of care.”
Regarding sustainability, the vendors said they recognize the end of the federal incentive payments “will shift a burden back onto providers,” but added they are confident in EHRs and the market's ability to generate innovated and cost-effective solutions.
Their letter was signed by executives from eight EHR vendors.
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