Navigating the Maze of Electronic Health Records

The HELP panel is trying to pull together legislation that clears several high hurdles.

Susan Lynch, a nurse practitioner, checks over a patient's electronic medical records, at the Central Florida Family Health Center in Sanford, Florida.
AP Photo/John Raoux
Rachel Roubein
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Rachel Roubein
Oct. 21, 2015, 9:30 p.m.

Christine Bechtel dropped off a copy of the Fed­er­al Re­gister at her doc­tor’s of­fice. The con­sumer ad­voc­ate was in the midst of a pro­longed battle to ob­tain elec­tron­ic cop­ies of her health re­cords from a primary care prac­tice whose em­ploy­ees seemed be­fuddled when told they had to provide them.

So Bechtel showed them the rules, and by the end of the roughly two-week or­deal, she had two files of health data, al­beit in a rather out­dated me­di­um: a CD-ROM.

Bechtel de­tailed her dif­fi­culties in get­ting her own pa­tient data at a June Sen­ate Health, Edu­ca­tion, Labor, and Pen­sions Com­mit­tee hear­ing, her an­ec­dote serving as a snap­shot of the prob­lems plaguing elec­tron­ic health re­cords that the pan­el hopes to fix in a med­ic­al-in­nov­a­tion bill likely to be in­tro­duced this year.

Earli­er this month, the com­mit­tee pol­ished off its sixth and fi­nal hear­ing on health in­form­a­tion tech­no­logy. It’s the first time that the pan­el has ex­amined health IT in depth since 2009, when the HITECH Act meant to en­cour­age its ad­op­tion be­came law as part of the stim­u­lus pack­age and fun­nelled bil­lions in­to health IT, Chair­man Lamar Al­ex­an­der said at the in­aug­ur­al hear­ing. The hours of hear­ings shed light on elec­tron­ic health-re­cord sys­tems that can’t al­ways ex­change in­form­a­tion between vendors, some­times en­gage in in­form­a­tion block­ing, and don’t con­sist­ently give pa­tients easy ac­cess to their own health data.

In late April, Al­ex­an­der and the pan­el’s top Demo­crat, Patty Mur­ray, an­nounced full-com­mit­tee work­ing groups for staff, hom­ing in on ways to im­prove elec­tron­ic health re­cords. Since then, the groups have held dis­cus­sions with health pro­viders, in­form­a­tion-tech­no­logy de­velopers, and oth­er ex­perts in the health IT field—a way of learn­ing what’s really hap­pen­ing on the ground.

Since the hear­ings have come to a close, the work­ing groups are set­ting pri­or­it­ies of items to be in­cluded in the bill, and through the pan­el’s six hear­ings, they already have in­sight in­to mem­bers’ thoughts on ways to ad­vance elec­tron­ic health re­cords.

Al­ex­an­der’s state­ments and pub­lic re­marks have noted that the com­mit­tee has “been work­ing with the ad­min­is­tra­tion di­li­gently for months to de­vel­op sev­en areas of agree­ment for le­gis­la­tion to ac­tu­ally achieve in­ter­op­er­ab­il­ity.” They are: De­creas­ing what he called “un­ne­ces­sary phys­i­cian doc­u­ment­a­tion,” let­ting pa­tients have easy ac­cess to their re­cords, hav­ing elec­tron­ic health re­cords be more ac­cess­ible to the whole health-care team, halt­ing in­form­a­tion block­ing, im­prov­ing stand­ards, bet­ter­ing re­cords’ se­cur­ity and pri­vacy, and mak­ing sure that a cer­ti­fic­a­tion of a re­cords sys­tem means what it says it does.

“We’ve really be­come very in­ter­ested in elec­tron­ic health care re­cords, which are es­sen­tial to pre­ci­sion medi­cine, which is the pres­id­ent’s pro­pos­al, and to the shared goal of Con­gress and the pres­id­ent to change the way we pay doc­tors from fee-for-ser­vice to the qual­ity of the ser­vice they de­liv­er,” the Ten­ness­ee Re­pub­lic­an said in an in­ter­view. “And in both cases, hav­ing good, func­tion­ing elec­tron­ic health care re­cords helps the doc­tor do a bet­ter job of serving pa­tients. And that pro­gram got off track.”

At the last hear­ing, Mur­ray said stand­ards need to be de­veloped so that doc­tors and hos­pit­als can un­der­stand data even if it comes from a dif­fer­ent elec­tron­ic re­cord sys­tem and from a dif­fer­ent hos­pit­al. A “net­work of net­works” needs to be cre­ated so that health pro­viders can share in­form­a­tion, she said, equat­ing this with a Ve­r­i­zon cell-phone user be­ing able to call a friend with a Sprint plan.   

And there are more top goals for the Wash­ing­ton state Demo­crat: De­vel­op­ing ro­bust se­cur­ity, fa­cil­it­at­ing easy ways for pro­viders to shop and com­pare elec­tron­ic re­cords sys­tems, and help­ing pa­tients have ac­cess to their health data.

“If you can eas­ily look up and down­load your bank state­ment, you should be able to do the same with your med­ic­al his­tory,” Mur­ray said at the fi­nal health IT hear­ing on Oct. 1. “But for far too many pa­tients, these ex­per­i­ences are very dif­fer­ent. … I think we can and must do bet­ter.”

There’s a bi­par­tis­an bill that ad­dresses a por­tion of these con­cerns that HELP Com­mit­tee mem­bers Bill Cas­sidy and Shel­don White­house in­tro­duced in early Oc­to­ber, and ac­cord­ing to a HELP GOP aide, Al­ex­an­der ex­pects that many of their pro­pos­als could be in­cor­por­ated in­to the com­mit­tee’s up­com­ing med­ic­al in­nov­a­tion bill. The Trust IT Act of 2015 aims to es­tab­lish a health IT rat­ing sys­tem so that cus­tom­ers can com­pare products, pro­hib­it health IT vendors from in­form­a­tion block­ing, man­date products meet se­cur­ity and in­ter­op­er­ab­il­ity re­quire­ments, and more.

In ad­di­tion, Al­ex­an­der has cri­ti­cized the ad­min­is­tra­tion’s speed in rolling out a third stage of rules that provide fin­an­cial in­cent­ives for the “mean­ing­ful use” of elec­tron­ic health re­cords. A Septem­ber re­port by the con­gres­sion­al watch­dog, the Gov­ern­ment Ac­count­ab­il­ity Of­fice—a re­port that Al­ex­an­der and some of the oth­er Sen­ate com­mit­tee chairs re­ques­ted—de­tailed trends culled from dis­cus­sions with rep­res­ent­at­ives from 18 non­fed­er­al or­gan­iz­a­tions work­ing on the abil­ity of elec­tron­ic health-re­cord sys­tems to ex­change in­form­a­tion, known as in­ter­op­er­ab­il­ity. Rep­res­ent­at­ives from 10 of these ini­ti­at­ives stated that the “mean­ing­ful use” pro­gram’s re­quire­ments “di­vert re­sources and at­ten­tion from oth­er ef­forts to en­able in­ter­op­er­ab­il­ity.”

Al­ex­an­der op­poses rolling out the last set of rules at the timetable the ad­min­is­tra­tion has set. Yet it’s un­clear wheth­er any changes would be wrapped in­to a lar­ger med­ic­al-in­nov­a­tion pack­age or a sep­ar­ate piece of le­gis­la­tion (and it could also be over­turned through the Con­gres­sion­al Re­view Act).

In the mean­time, the com­mit­tee is fo­cus­ing on im­prov­ing health in­form­a­tion tech­no­logy—an at­tempt at cre­at­ing a ma­jor med­ic­al-in­nov­a­tion bill both parties can sup­port, just like the chair­man and rank­ing mem­ber have done in the past.

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