CHICAGO—A former federal health IT coordinator has come out against a provision in a proposed CMS rule that would significantly weaken a requirement for healthcare providers to promote patient access to their healthcare information.
In a speech Sunday at the Healthcare Information and Management Systems Society's annual convention in Chicago, Dr. Farzad Mostashari called for patients to ask providers to provide them with electronic copies of their records. He said consumer action is needed to demonstrate to the feds that there is patient demand for such access and that the CMS rule should be withdrawn. “Let's start really nailing the hell out of access,” Mostashari said.
His comments came in response to CMS rulemaking Friday. Mostashari insisted that the national push for interoperability of patient information should include ensuring that patients have access to their data. That's currently required by law but often impeded by lack of sufficient effort and attention by healthcare providers.
Mostashari, who now heads a healthcare consulting and information technology firm, led HHS' Office of the National Coordinator for Health Information Technology from 2011 to 2013. Before that he served for two years as deputy national coordinator and as New York City's assistant health commissioner.
The current Stage 2 meaningful-use rule requires that hospitals, office-based physicians and other “eligible professionals” attest that 5% of their patients have used the providers' EHR to electronically view, download or transfer their records, known as VDT. But the CMS' 210-page proposed rule would reduce that requirement to demonstrating that VDT was possible by attesting that a single patient had done it.
Mostashari noted that with Stage 1 meaningful use, hospitals were required to provide electronic copies of their records to patients if patients requested them. Program data showed that two-thirds of hospitals that attested to that measure “did so with a zero denominator, not a single patient asked,” Mostashari said.
With the new rule, only requiring one patient to have electronic access to their records would produce similar results regarding VDT, he said. “I'd like to say that I hope that even if they do that, people will have seen the benefits” of accessing their records, Mostashari said. “But I'm afraid what will happen is we'll go back and two-thirds (of providers) will attest with one” VDT.
Patients need to be made aware of their right to electronic access to their information and they need to be coached on how to do it, he said. Clinicians, too, need to get used to providing copies of records, he added.
Such outspoken criticism of federal health IT policy by a former ONC coordinator is unprecedented. Mostashari said he was mindful that his predecessor at the ONC, Dr. David Blumenthal, gave him the benefit of the doubt and remained silent on policy issues, as have other ONC chiefs.
Until today, he said, “I've been giving this administration that love,” he said, knowing that the current group of people in federal health IT policymaking, including current ONC chief Dr. Karen DeSalvo, are hard-working and sincere. “But for the first time I'm taking issue,” he said.
A 60-day public comment period on the rule will start when it is officially published in the Federal Register, which could come this week.
As OHC head, Mostashari was a champion of the federal Blue Button initiative, which also was endorsed by President Barack Obama as a way for patients to have ready access to their medical records. In his HIMSS speech Sunday, Mostashari said Blue Button technology, pioneered at the Veterans Health Administration, has resulted in more than 1.5 million downloads of records by veterans.
In an interview after his speech, Mostashari said he was inspired to issue the call for consumer action by patient advocates at the symposium. “It really did arise out of a sense of what if people asked and there was demand,” he said.
“If this proposed rule stands, it would roll back a lot of progress that's been made incorporating patient engagement into workflows,” he said. “To meet even a low threshold, providers have had to change their processes to engage patients” and let them know “they have access to that information. That's the biggest potential loss.”
