Senate HELP Committee again addresses EHR interoperability

The Senate Health, Education, Labor, and Pensions Committee continued its efforts to improve EHRs and interoperability during a hearing on June 10.

The goal is to “identify the five or six steps that we can take working with the administration to improve electronic health records—a technology that has great promise, but through bad policy and bad incentives has run off track,” said Sen. Lamar Alexander (R-Tenn.), chairman of the Senate committee. He advocated for the industry to take on the challenges itself but said Congress might have to pass a law to make progress.

Alexander said EHRs can be brought “back on track” to become “a tool that hospitals and physicians can look forward to using to help their patients instead of something they dread.” He noted that doctors are “spending more time taking notes than taking care of patients, and they are spending a lot of their own money on systems that have to comply with government requirements.”

According to Alexander, all hospitals and most physicians that tried were able to meet Stage 1 Meaningful Use requirements but not so with Stage 2: the requirements are “so complex that only about 11 percent of eligible physicians have been able to comply so far, and just about 42 percent of eligible hospitals.”

Several industry stakeholders shared their thoughts during the hearing. Thomas Payne, MD, medical director of IT services at the University of Washington School of Medicine and chair-elect of the American Medical Informatics Association (AMIA) Board of Directors, said the Centers for Medicare & Medicaid Services should delay Stage 3 “until it’s improved.” However, Christine Bechtel, president of Bechtel Health and chair of the Health IT Policy Committee’s Consumer Work Group, warned that delaying Stage 3 would prevent some patient engagement advances, including the requirement for “a greater percentage of doctors to share information electronically not just with patients but other doctors” as well as “lose a technical fix” in the form of application programming interfaces “that would help us to unlock the data that is currently siloed in patient portals.”

Nonetheless, Payne referenced AMIA’s recently released EHR 2020 Task Force report which offers 10 recommendations for creating a person-centric, learning healthcare system over the next five years. “The simple message resonating among the task force’s recommendations: slow down regulation to accelerate progress,” he said. “Ensuring CMS does not rush to get to the next stage of Meaningful Use, but rather works to help the private sector accelerate optimization of the tools and regulations that are already in place; and reorienting ONC’s certification program to test true interoperability by testing how systems both send and receive information are among the key steps HHS should take in the near-term. Should the regulatory pressure continue, stakeholders may look to Congress to intervene.”

Congress “would engender genuine and lasting impact by enabling all patients to have their medical record, not just a summary of their record, available in standardized, machine-readable formats,” Payne said, adding that “it is unconscionable that in 2015, with the widespread adoption of electronic health records, a patient must still print and scan their medical record when they change to a new physician.”

Bechtel said the U.S. healthcare system is “struggling to foster the kind of exchange that will drive better care and smarter spending” because many healthcare organizations “still treat health data as a close-hold business asset, when it should be treated as a public good.”

Neal Patterson, CEO of Cerner Corporation, called healthcare organizations’ blocking of the flow of information immoral. “Healthcare is too important not to change." He took some responsibility for the lack of interoperability citing the competitive instinct that has led to technological silos. Vendors and providers alike “must enable sufficient transparency around data sharing to allow keeping a watchful eye on behaviors in our industry. Whether intentional or unintentional, behaviors that restrict patient choice, throw up roadblocks to true interoperability, or use control over data to further market share should be challenged. None of us have a perfect record, and we can all do better.”

Health IT platforms must be open and interoperable, Patterson said. “Getting to full interoperability requires active cooperation among all the vendors, and their acceptance that once technological silos are eliminated, they will have to compete on innovation, quality and cost. We do not have this yet in health IT, but this kind of dialogue at the national level has a chance of creating real change.”

The committee will hold a follow-up hearing on June 16.