Health Information Management

Congress tackles EHR woes, information blocking, and interoperability

HIM-HIPAA Insider, August 3, 2015

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Congress has taken notice of healthcare providers’ woes and frustrations dealing with electronic health records (EHRs) and lawmakers are determined to work out a solution that promotes progress in health technology as well as better care for patients.
 
Federal incentives to encourage physicians and hospitals to adopt EHRs have begun to dry up as CMS winds down its Medicare and Medicaid EHR Incentive Programs. Total Medicare bonus payments to eligible professionals and hospitals have decreased and will last through 2016, but effective in 2015, CMS has started imposing penalties on participants who don’t achieve meaningful use with their EHRs.
 
That, combined with the costs to implement and maintain EHRs as well as burdensome federal regulations (according to physicians), is calling negative attention to the $30 billion incentive programs. To compound matters, all of this is occurring at a time when regulators are trying to push ahead on nationwide interoperability.
 
U.S. Sen. Lamar Alexander (R-Tenn.) doesn’t want to diminish those frustrations, he wants to resolve them by addressing problems with the six-year-old program.
 
The Senate health committee chaired by Alexander will ask CMS to delay the third and final stage of meaningful use to allow the panel time to submit recommendations on the incentive program.
 
Those recommendations are being written in a format HHS could adopt through rulemaking instead of legislation as part of a bipartisan effort between Alexander and Sen. Patty Murray (D-Wash.). The senators anticipate that if new legislation is needed, however, it could be developed in early 2016.
 
Meanwhile, Alexander’s committee continues to hold hearings with industry experts on how to achieve interoperability across the nation. The latest hearing on July 23 focused on information blocking, which is also addressed in the 21st Century Cures Act—a bill that passed the House July 10.
 
Information blocking refers to obstacles that prohibit electronic sharing of a person’s health information between computer systems. Such obstacles, intentional or not, naturally derail efforts to seamlessly share data across platforms and systems, and subvert the intention behind EHR systems.
 
Alexander speculated information blocking may be occurring for several reasons, including legitimate privacy concerns by physicians or hospitals as well as targeted business strategies. It also raises the question, he said, of whether the publicly funded push to implement EHRs inadvertently encouraged this type of behavior.
 
In prepared remarks prior to the hearing, Alexander cited examples of problematic information blocking. For instance, a patient who is typically treated at Hospital A is admitted to the emergency department at Hospital B. Hospital A engages in some form of information blocking, which prevents Hospital B from gathering information about the patient.
 
This may occur because Hospital A refuses to share the information—possibly for privacy reasons or concerns about data security—the two EHR systems can’t talk to each other, or Hospital A wants to charge the other hospital a large fee to send the records.
 
Alexander cited another example in which a physician at a clinic across the street from a hospital had to manually deliver copies of his patient notes to the hospital to be entered into its EHR system whenever he admitted a patient there because the two facilities had completely separate EHRs and vendors.
 
An April report from the Office of the National Coordinator for Health Information Technology (ONC) described just those types of information blocking scenarios, Alexander said. The report explained how “bad actors” in the industry are creating technical, legal, and business barriers that may not be in the best interest of patients and their care.
 
“It might be physicians and hospitals blocking patient information from being shared with competing physicians and hospitals to keep patients,” Alexander said. “Or it might be electronic health records vendors blocking information so they can increase their market share.”
 
There are those within the healthcare industry who view information blocking as “rational competitive practice” by for-profit businesses in a competitive industry, Alexander said. It would be against their business interests to make it easy for patients to go out of network.
 
Witnesses who testified during the July 23 Senate hearing—health informatics experts and physicians—said they’ve seen many instances of EHR vendors creating inappropriate barriers or providing substandard data quality. They said, in many cases, vendors simply charge $10,000 to $40,000 per practice to implement and maintain interfaces with a system. There are also legal gag clauses in contracts with vendors.
 
Conversely, witnesses representing vendors and their advocates said the responsibility of health data exchange ultimately falls to providers, many of whom are struggling to afford it. The federal government then, they said, could directly incentivize interoperability between systems in the same way it created incentives for physicians to adopt EHRs.



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