The Senate Health, Education, Labor and Pensions Committee is asking to delay Stage 3 meaningful-use rules, its chairman, Lamar Alexander (R-Tenn.), said during a news conference Thursday.
This will be one of several recommendations his committee will make to the Obama administration in a push to expand the use of electronic health records, which some providers say are costly and time-consuming.
Alexander's staff and Ranking Member Patty Murray (D-Wash.) have been meeting with committee members' staff weekly and meeting regularly with experts and administration officials to relay their policy suggestions.
The directives are intentionally being drafted as regulations that can be implemented by HHS Secretary Sylvia Matthews Burwell via rule-making versus legislation. This ensures they can be adopted quickly, Alexander said.
If legislation is ultimately needed to get some of the recommendations implemented, they would likely be rolled into the Senate's companion bill to the House's 21st Century Cures legislation, a healthcare innovation bill that Alexander expects to be drafted and voted on early next year.
“We want to keep going forward (with the adoption of EHRs), no one wants to turn back,” Alexander said.
In March, the CMS issued proposed rules for Stage 3. This final stage requires providers to send electronic summaries for 50% of patients they refer to other providers, receive summaries for 40% of patients that are referred to them and reconcile past patient data with current reports for 80% of such patients.
What's concerning providers is that this stage differs from the others in the degree to which, to fulfill its requirements, a medical provider must depend on others. According to a July 20 policy analysis by Niam Yaraghi, a fellow in the Brookings Institution's Center for Technology Innovation, this means if providers do not send electronic summaries, the medical provider who was supposed to receive them will fail to comply with the rulemaking.
This is a very likely scenario as only a quarter of physicians say they are compliant with Stage 2 requirements.
“This leads to a situation in which even tech-savvy providers will not be able to fulfill the requirements of the third stage of the meaningful-use program, regardless of their intentions and efforts,” Yaraghi said in the analysis.
Provider groups such as the Medical Group Management Association and the American Medical Association have also been pushing for a delay. As of now, the CMS expects to begin enforcing Stage 3 requirements in 2017.
Other recommendations the committee is likely to make to the Obama administration this fall include standards clarifying that patients own their health data, a greater need for interoperability, heightened security requirements for patient data, and more user-friendly EHR systems, Alexander said.
The news briefing came after a Senate Health Committee hearing on the practice of “information blocking.” Alexander defined the term.
“If I found myself suddenly at the Vanderbilt University Medical Center emergency room and the doctors there wanted to get my paperwork from the hospital and doctors I usually use—information blocking means that there is some obstacle getting in the way of my personal health information getting sent to them,” Alexander said at the hearing.
This could happen in several ways, including a hospital refusing to share information or electronic systems at both hospitals not talking to each other.
“There is substantial evidence that some organizations are intentionally setting up barriers between their systems and other systems, overcharging or creating technical or legal barriers to providers who wants to access information through the system they've purchased, or both,” Murray said at the hearing.
The witnesses gathered seemed to be generally against any substantial new regulations to address this issue, as the healthcare industry is still trying to comply with all federal rules.
A couple of witnesses further noted that the issue of data blocking appears to be largely taken care of as the CMS moves away from a fee-for-service to a value-based purchasing system. In April, the Office of the National Coordinator for Health Information Technology issued a report stating that most allegations of information blocking involve provider business practices rather than health IT issues.
“Therefore, attempts to redress the root causes of information blocking must address the unwillingness of some providers and their EHR partners to share and exchange data,” said Dr. David Kibbe, a senior adviser to the American Academy of Family Physicians and CEO of DirectTrust, during the hearing. His group is a not-for-profit working to create a national framework for secure electronic exchange of personal health information.
“That unwillingness originates in the current business models of some healthcare provider organizations, and the healthcare industry in general, wherein fee-for-service payment creates disincentives for sharing of health information and rewards information hoarding, or at least the delay of timely information exchanges.”
The greater emphasis on value-based purchasing helps to address this issue as patient satisfaction is a key metric that determines payment, thus disincentivizing the hoarding of patient information, Kibbe and other witnesses argued.
Correction:
This article initially misidentified Alexander's Senate committee.
