HELP Committee seeks suggestions for interoperability

The Senate Committee on Health, Education, Labor & Pensions discussed the Meaningful Use program and ongoing interoperability challenges during its hearing on March 17. At the end of the hearing, panel members shared their suggestions for improvements.

“It’s time for a reboot of the Meaningful Use program,” said Sheldon Whitehouse (D-R.I.). Comparing interoperability to building highways, he said organizations are building their own. “If you get the exchange part right, so much of the rest falls into the place. We’re doing this very inefficiently and ineffectively. We’re focusing of the most remote part of the system—the physician’s desk without building the internal infrastructure that allows those points to all connect. If you get that right, people will have to connect because there is a value proposition from the system. We won’t have to make an artificial value proposition of subsidy and proposition.”

The most expensive people in the healthcare system are in nursing homes, he said. By not including those providers in MU, the program has “made a really stupid tactical error in the rollout of HITECH. When you cut out behavioral health providers from Meaningful Use, you’ve made another stupid decision and we refuse to fix those decisions.”

Whitehouse also said there are vendor business practices to be worried about such as not putting connecting fees into their client pitches. Another issue is the question of data ownership. “Data should be ultimately the property of the patient.” Solving the issue is important “so it’s clear how privacy is protected.”

There is a role for government in protecting against some of the possible abuses, he said.

Committee Chair Lamar Alexander (R-Tenn.) asked each member of the panel what they would do when considering “the $30 billion spent, the promise of the idea, and the fact that half of doctors part of Medicare reimbursement would rather take a penalty than be involved in EHRs, what would you do to try to realize the potential?”

“Begin with transparency,” said Julia Adler-Milstein, PhD, assistant professor of information and of health management and policy at the University of Michigan. She suggested a Consumer Reports-style set of information that compares systems, costs and value. Without transparency of such basic information, “we can’t have a robust market around the tools.”

Robert Wergin, MD, president of the American Academy of Family Physicians, said healthcare needs “EHRs that work with the workflow of my day-to-day operations…and help me deliver proper care.”

Peter DeVault, Epic’s director of interoperability, said MU was meant to be an adoption and interoperability program. “It’s been largely successful on the adoption front but rather than focusing on interoperability and describing the kinds of outcomes people wanted, it ended up being an EHR design session by committee.”

If there were incentives for the kinds of outcomes everyone wants, “there would be incredible innovation to make that happen in a variety of ways.”

Angela Kennedy, EdD, MBA, head of the department of health informatics and information management at Louisiana Tech University, discussed her experience caring for her daughter with cystic fibrosis after she was misdiagnosed for years. Over the years, none of her daughter’s providers could share data. “We have to make sure we can exchange data in a way that providers receive the information they need to care for the patient.” Data, wherever created, “is going to lead to better continuity of care. It’s critically important that we continue to work toward interoperability and remove the barriers whether on the side of the developer, provider or maybe with the consumer. I don’t think we’re moving fast enough on this issue.”

The committee agreed that this issue warrants further discussion. “We’re a long way from where we should be,” said Whitehouse. “We’ve got a lot at stake. The possibilities are immensely positive and the hazards are solvable and negotiable. We need to be doing right not wrong and doing smart not stupid.”