The House version of the 21st Century Cures legislation gliding through the current lame-duck session of Congress takes aim at health information technology policies.
Broadly, it seeks administrative simplification of federal health IT programs.
It would require HHS to set a goal and come up with a strategy to reduce “regulatory or administrative burdens” within one year of passing the law.
Included in its legislative punch list are reductions in “documentation requirements, relating to the use of electronic health records.” Other provisions simplify providers' federal requirements for “meaningful use” of health IT systems, merit-based and alternative payment models, and health IT certification.
HHS must set criteria for the voluntary certification of health IT for pediatrics and formally adopt those EHR testing and certification criteria within two years of passage.
The proposed law would allow documentation by scribes to meet “electronic medical record documentation requirements” under Medicare and Medicaid, provided the physician verifies and signs the documentation.
Dr. Jeffrey Kreamer, CEO of Best Practices Inpatient Care, a 55-practitioner hospitalist group in Long Grove, Ill., said he has about 14 to 15 scribes working there on a daily basis. He considers the provision Congress' way of saying, “We're not going to make the documentation burden go down, so you might want to get somebody to help you.”
Arguably the most potent new provision of the proposed law references the rather wonky concept of data blocking, redubbed “information blocking.”
First, the proposed law would require HHS though rule-making to impose, as a condition of certification, that health IT developers do not engage in information blocking or “any other action that may inhibit the appropriate exchange, access and use of electronic health information.”
The law also gives enforcement authority to HHS' Office of Inspector General.
In addition, the Office of the National Coordinator for Health Information Technology at HHS can refer cases of information blocking. Monetary penalties can run up to $1 million per violation, but are applicable only to developers.
Providers found by the OIG to be in violation are subject to “appropriate disincentives.”
Leslie Krigstein, vice president of congressional affairs for the College of Healthcare Information Management Executives, worries whether enforcement activities may be premature.
“Before we start running around accusing folks of information blocking, there are some fundamental technical and policy barriers that we've got to get out of the way, Krigstein said.
Under the proposed law, HHS may exempt hospitals, physicians and other eligible providers from penalties if they don't comply with meaningful use requirements if their vendor's products become decertified.
The bill also requires HHS to collaborate with the healthcare industry to come up with a “trusted exchange framework” to ensure full network-to-network exchange of health information.
The framework shall include a “common method for authentication of exchange participants.”
The proposed 21st Century Cures Act would require the Government Accountability Office to evaluate current methods used in matching patients to their electronic records and produce a report within two years. CHIME members view that favorably, according to spokesman Matthew Weinstock.
CHIME, which is leading a national search for a scalable, patient-matching solution, would like the time frame to be shorter, but, “within that timeline, we should have our patient identification challenge solution” identified,” Weinstock said. “That should be part of that conversation.”
The GAO must produce a similar study and report within 18 months on patient access to their own health information.
(This story was updated at 1:05 p.m.)
