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Senators Seek to Address Concerns About Electronic Health Records

By Melanie Zanona, CQ Roll Call

June 10, 2015 -- Concerns about a $30 billion federal program meant to encourage the adoption of electronic health records are likely to be addressed in a Senate medical innovation bill later this year, according to Health, Education, Labor, and Pensions Chairman Lamar Alexander.

"This will be a central piece of our innovation project...that's why I'm spending so much time on it," the Tennessee Republican told reporters after a recent hearing. "The purpose of our innovation bill is to align federal polices so cures, treatments and devices can get through discovery to the medicine cabinet. This is just a part of it, but an important part."

Alexander said his panel is on track to consider its version of legislation to speed medical cures after it finishes a planned reauthorization of higher education law in September. Parallel efforts in the House have been on a much quicker timeline, with the full chamber expected to consider its so-called 21st Century Cures bill (HR 6) as early as next week.

Lawmakers in both parties largely agree the government's six-year-old Meaningful Use Program included in the 2009 stimulus package (PL 111-5) needs improvements. The effort was intended to incentivize doctors and hospitals to adopt electronic medical records, in the belief that they could facilitate information sharing and improve the quality of care.

But more than 250,000 physicians have struggled to meet the program's second phase of requirements and have begun losing one percent of their Medicare payments as part of a penalty, according to the Centers for Medicare and Medicaid Services. The final rule for the next stage of the program is expected later this year.

"Physicians and doctors have said to me that they are literally terrified on the next implementation stage of electronic health records, because of its complexity and because of the fines that will be levied," Alexander said at the hearing.

One witness suggested that Congress delay the third phase of the program until improvements are made. However, Christine Bechtel, advisor for the National Partnership for Women and Families and chairwoman of a Health IT Policy Committee Consumer Workgroup that advises the federal government, cautioned that could squelch a technical fix that would help us unlock data that is currently siloed. "I just want to recognize that wholesale delay of Meaningful Use stage three should be very thoughtfully considered in light of the things we would give up," she said.

Alexander, however, said it "might be better to step back on some of the rules and take some advice on how to improve things."

Five or Six Steps

Wednesday's hearing was part of efforts to identify "five or six" steps to improve electronic health records, according to Alexander. In addition to weekly meetings between staff and regular communication with the Health and Human Services Department, there will be at least two more hearings that will address the burdens facing physicians and the control that patients have over their own health information.

Potential solutions identified Wednesday include improving documentation requirements for doctors, refocusing and streamlining regulations, establishing unique identifiers for patients and supporting patient-centered care delivery.

"No place knows where my records are other than me. There is no system," said Neal L. Patterson, co-founder and chief executive officer of Cerner Corp. "And everybody is very afraid and cautious of letting records out because of [Health Insurance Portability and Accountability Act federal privacy rules], which has very stringent penalties for sharing patient information."

But one of the biggest challenges in improving electronic medical records is getting systems to talk to each other, an issue known as interoperability. Provisions meant to enhance communication between different systems were included in the House Cures bill and related language is likely to land in the Senate version as well.

Witnesses suggested implementing a public-private partnership on interoperability governance in order to provide "clear rules of the road," developing functional data standards, establishing transparency in the free flow of information and preventing deliberate information blocking by a company or provider.

"The goal should be to design and implement a secure health IT ecosystem that enables an easy exchange of health information in timely and cost-effective ways," said Craig D. Richardville, senior vice president and chief information officer of Carolinas Healthcare System. 

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