Health information technology experts told a U.S. Senate health committee that they need to use persuasion rather than legislation to fix problems with the multibillion-dollar federal health IT program.
The hearing focused on the decades-old problem of exchanging patient information between healthcare organizations' electronic healthcare-record systems, a lack of so-called interoperability.
Committee Chairman Lamar Alexander (R-Tenn.) called the inability to exchange health information “a glaring failure.”
Alexander acknowledged the $30 billion federal EHR incentive payment program has increased EHR adoption. The program was created by Congress as part of the American Recovery and Reinvestment Act of 2009.
For the first few years of the program, legislators largely let the Obama administration run the program. That changed when the congressionally mandated increases in standards to achieve “meaningful use” kicked in last year. The rules require providers to meet certain standards to receive program payments and avoid penalties.
Alexander said the complexity of the program's Stage 2 rules now in play have caused compliance difficulties while its proposed Stage 3 rules have “terrified” providers. He added the hearing was meant to identify steps to improve the policy and encourage participation.
The expert witnesses Tuesday did not offer specific legislative fixes.
Instead, they called on Congress to use its influence, most commonly with HHS, to tweak existing programs.
“The role for Congress right now is to nudge the administration” to make programmatic improvements, witness Christine Bechtel said in an interview.
Bechtel, a consultant who previously served on the federally chartered Health IT Policy Committee representing consumers, called for technologies that would enable patients to download, store and “curate” their own medical information on mobile devices.
“If I have the data, I can spot errors, avoid repeat tests, detect fraud, help facilitate coordinated care, and much more,” Bechtel said in her written testimony. “I can be the curator of my own health record, sharing it where and when it is needed to improve my care, and for other important purposes like research into precision medicine.”
Bechtel said, “We are close to achieving this vision.”
Cerner Corp. founder and CEO Neal Patterson gave touching, personal testimony about the need for better interoperability. Patterson said his wife, Jeanne, has been battling breast cancer since 2007, and that portions of her records are kept in more than 20 different health organizations' EHRs. For her, interoperability is achieved by moving paper records herself.
“I think it is a failure of all of us to have, in 2015, the fact that Jeanne carries bags (of records) to her doctors' appointments where she is going to see a new doctor or specialist,” Patterson said.
Still, Patterson said, he foresees the day when patients can go to a new doctor, who can click a button on an EHR and compile that patient's most relevant information.
Patterson, who serves as the health IT industry's representative on the Health IT Policy Committee, stopped short of calling on Congress to do anything specific.
Dr. Thomas Payne, the American Medical Informatics Association's board chair-elect and medical director of IT services at University of Washington Medicine, in his written testimony, told the committee it should “take up legislation” during this or the next session, but he, too, stopped short of specific recommendations on what laws Congress should enact.
Instead, Payne said lawmakers should use their influence to “encourage and support” the executive branch to reform billing documentation requirements; promote alternative payment models; simplify and clarify meaningful-use regulations; and beef up federal EHR certification requirements to ensure EHRs are tested and capable of “true interoperability.”
An AMIA report released in May on health IT program improvements could be a road map for Congress going forward as Alexander read from it at length during the hearing.
Payne said AMIA supports two “methodologies” for promoting interoperability. It supports the patient-centric approach, also advocated by Bechtel.
But current methods of data-sharing date back to 1990s technologies that are “a little bit dusty these days,” Payne said. So, moving forward, some patient information should be released via widespread deployment of common application-programming interfaces, Payne said.
Payne said while he was impressed at how well members of the committee had been briefed, it was also clear senators had listened to complaints from their constituents, both patients and providers, demanding improvements.
The committee has another hearing scheduled Tuesday on what providers and HHS can do to improve EHR usability.