Viewpoint: Va. bill raises fears, defenses about future of EHRs, HIEs

On Jan. 14, Virginia Senator Stephen H. Martin presented Senate bill SB No. 1275 to the General Assembly of the Commonwealth. As a reviewer of such bills for his provider, Colin Banas, MD, CMIO of the VCU Health System in Richmond, Va., recognized that if this legislation passes, it could ostensibly make healthcare information exchange and EHRs illegal. Read the experience in his own words.

As an internist and the CMIO for an academic health system in the Commonwealth’s state capitol, I am asked to review the legislation for potential impact, particularly in the realms of education, research and, most importantly, patient safety.  At first blush and for someone quickly perusing the content, this bill proposes to place “limitations on the use, storage and processing of medical data.”

OK, seems innocuous enough. Perhaps this guy is seeking some extra security around medical record confidentiality. That’s a pretty hot topic these days. Let’s see where this is going.

The very next sentence in the summary: “(prohibit) health information exchange…”

Stop the presses. Now my interest is piqued and as a CMIO my defenses are up, as are my fears.

After giving the legislation a thorough read, I found the bill proposes key themes that fly counter to the very purpose of my role and the national construction of electronic infrastructure in which I am committed to. Namely, this bill would prevent not only our health system’s (and all Virginia hospitals for that matter) participation in a statewide and eventually nationwide health information exchange, but also prevent “the analytic and statistical processing of medical records from multiple patients for the purposes of medical diagnosis or treatment, including population health management.”

Huh? It’s illegal to analyze data for the purposes of making patients better? Now I’m angry.

For those of us invested in the realm of informatics, there is an adage we often recite, “In God we trust; everyone else must bring data.” To realize the true benefits of an EMR, there are a couple of key elements that we must support—namely we need it to be ubiquitous to access, it must be able to contribute to the continuum of data converting to information which translates into knowledge and eventually wisdom, and by doing so, it will enable real-time clinical decision support. Notice the importance of data and their ability to flow and be aggregated and analyzed—it’s the lynchpin.

My fears are that such a bill would stifle and subvert the years of painful progress we’ve made in EMRs and clinical data exchange to date. I also fear that limitations on the storage and analysis of medical data (even when properly anonymized and de-identified) would grind to a halt research and education efforts.
There goes personalized and “precision” medicine. We can’t very well target a genome or a population if we can’t store, analyze, and exchange vast quantities of data. There goes participation in key NIH initiatives such as the Clinical and Translational Science Award (CTSA) of which VCU is a member.  Success in medicine and all throughout history is predicated on exchange of information and ideas.

This legislation targets the very same efforts that lead to the clinical decision support success stories that the National Coordinator for Health IT, Farzad Mostashari, MD, ScM, is hoping to expand on and the kind of unique success stories that institutions like Lucile Packard Children’s Hospital can tell when they use real data to answer a previously unanswered question for a real child in real time and make a real difference in that child’s treatment plan and outcome. (Evidence-Based Medicine in the EMR Era, N Engl J Med 2011; 365:1758-1759).

The bill is in direct opposition to the milestones and goals embedded in the American Recovery and Reinvestment Act and Meaningful Use Stages 2 and 3, where interoperability, data exchange and data analytics all play major roles in the ultimate goal: improved patient outcomes.

If I may make a clumsy corollary: it feels like this bill would be equivalent to opposing the federal interstate highway system to some extent.

In my internal response to our leadership, I make the case that legislation like this will harm patients while hamstringing our research and academic endeavors. We’ve come too far to undo decades of progress. The public expects interoperability and our patients deserve it.

This bill was referred to the committee on education and health, where it will be debated in the days to come. Most likely it will die quietly in committee, but still, one has to question the motivation behind it and whether it is a harbinger for other similar bills in other areas. If so, how can we, as leaders in the realm of medical informatics, better educate the public and our patients on just how important EHR technology is to the future of healthcare?