(This story was updated at 5:15 p.m. ET.)
A Senate committee's ideas for boosting the interoperability of electronic health-record systems and increasing their usability harken back to a 2004 plan authored by the father of the modern health information-technology movement.
The Senate Health, Education, Labor and Pensions Committee Wednesday released a bipartisan draft of proposed legislation aimed at improving health IT for doctors and their patients. It calls for combining existing data-sharing networks with an eye toward developing not only a model interoperability framework—of which there has been no shortage over the past decade—but more importantly to help foster a “network of networks.”
The concept is similar to the national health IT battle plan set forth by the first head of the Office of the National Coordinator for Health information Technology, Dr. David Brailer. His vision was that providers would first communicate through regional health-information organizations, which in turn would link together in a proposed national health information network.
The regional exchanges have developed, some better than others, but their connection to a national system remains a work in progress.
The Senate's proposal would provide a missing link in that network, a “digital provider directory.” That's a sort of “white pages” of providers' computer addresses to facilitate peer-to-peer communication between providers' electronic health-record systems. That would aid, for example, the sending and receipt of care summaries.
The proposal also has two provisions to improve patient matching of medical records. First, it calls on the U.S. Government Accountability Office to study methods for patient matching, apparently lifting a 1998 congressional ban on any federal funding to create a national patient identifier. It would also establish a set of patient demographic data elements, such as date of birth, and a standard format for entering data into those fields, “to facilitate interoperability and streamline quality reporting,” according to the proposal.
Committee Chairman Lamar Alexander (R-Tenn.) in a news release welcomed feedback from providers and health IT experts.
The College of Healthcare Information Management Executives, the professional association of hospital chief information officers, lauded the draft bill for addressing one of its pet issues, including patient matching, noting that accurate patient matching would facilitate health information exchange and interoperability.
To that end, CHIME this week launched a timely $1 million challenge to find a private-sector solution to the matching problem.
The Senate proposal also would combine the Health IT Policy Committee and the Health IT Standards Committee, which advise the ONC, into the HIT Advisory Committee.
Physician informaticist Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center in Boston, co-chair of the Health IT Standards Committee and an adviser to federal IT policymakers, said the consolidation “is very reasonable.”
“Several of the meetings of the Policy and Standards committees are done jointly already," he said.
Halamka said there's only one part of the draft bill he can't support—the section on a government-sponsored, health IT rating system.
He says that does not make sense for increasingly heterogeneous information technology.
That job is better performed by existing organizations, such as KLAS Enterprises, he said. The Orem, Utah,-based health IT market watcher announced in October it is working with vendors to reach consensus on a private-sector interoperability rating system.
Brailer said he sees the HELP Committee bill as “a return to a market-based oversight system” in health IT, with patients having more access to their health information.
Providers and local health information exchanges, or HIEs, are hindered by federal privacy laws.
Brailer agrees with the bill's aim, adding that patients should be able to have any information about them sent to their medical record, and “that record could be (in) the NHIN.” The control of the network, Brailer adds, will transfer from the provider to the patient.
“We're not going to go back and repeal what happened,” said Brailer, referring to 2009 federal law that created the EHR incentive-payment program, with its EHR certification requirements for vendors and meaningful-use targets for providers. The changes in the HELP bill, “I'm happy with,” he said.
Robert Tennant, senior policy adviser to the Medical Group Management Association, saw a lot to like in the HELP bill.
“It includes a word that we rarely see, and that's usability,” Tennant. “That's just so critical.”
But Tennant said the feds need to be “cautious” about the call for certification of EHRs by medical specialty. It's fine, if it's voluntary, he said, but problematic if it's required to qualify for the EHR incentive-payment program.
“If they go to a subspecialty certification requirement, there could only be a handful of products certified for the specialty so the choice might be limited and the costs might go up,” he said.
Public comments on the Senate committee's 68-page proposed legislation (PDF) will be accepted through Jan. 29. A committee markup of the initial bill is scheduled for Feb. 9.