The US Senate’s Health, Education, Labor & Pensions Committee continues its march toward a world where interoperability is the norm and various competitive systems work together no matter the markets or locations they serve. The attention of the committee is currently focused on a possible delay to the Stage 3 of meaningful use. The committee’s chairman, Republican Senator Lamar Alexander, has gone so far as to ask the Department of Health and Human Services to look into doing so.
As recently as a few weeks ago, the committee heard from members of the health IT community.The most recent committee saw testimony from the likes of Allscripts CEO Paul Black and DirectTrust CEO David C. Kibbe, MD, among others. Kibbe said that interoperable health information exchange is being hindered, despite progress in the past two years. However, he said he feels as though information blocking by healthcare provider organizations is still a problem, and that exchange of direct messages and attachments is needed now.“In my opinion, the responsibility for assuring secure interoperable exchange resides primarily with the healthcare provider organizations, not the EHR vendors, and not the government,” Kibbe said. “Healthcare provider organizations must come to realize that acting in the best interest of patients is to assure that health information follows the patient and consumer to whatever setting will provide treatment, even if that means in a competitor’s hospital or medical practice. And they must demand collaborative and interoperable health IT tools from their EHR vendors to make this routine and ubiquitous as a practice in every community in the United States. However, there is a role for government to encourage and incentivize collaborative and interoperable health information exchange.”
Kibbe went on to explain that persisting information blocking problems include: local EHR and provider organization policies; EHR product design or implementation flaws; lack of or inadequate product/service support; high pricing for HIE-enabled software upgrades; and registration and “whitelisting” requirements for message exchange.Allscripts’ Black testified, though, that interoperability among vendors and among providers does happen. Though he does have stake in the game, he said, “It is important to note that there are many examples of providers who have worked through the process of establishing connectivity and are making it work. It is true, however, that today not all stakeholders in the healthcare industry seem to be equally motivated to make information liquidity a reality.”
This most recent meeting focused on lack of interoperability, but what’s important about this committee is that it is helping to advance the conversation on some obvious and contentious issues that seem only to have lurked in the corners until now. For example, for most of this years, Alexander, and Democratic co-chair Parry Murray (Wash.) have tried to push for health IT reform. Given the partisan politics in most areas of Washington, D.C., these two have found what appears to be some common ground in getting us to a more efficient, centrally aligned and sharing place.During another recent hearing, Alexander said that EHR technology frustrates providers and could inhibit use “We’ve got to get to a place … where more doctors, particularly the smaller physicians’ offices, want to adopt these systems, can afford the cost and can be confident that their investment will be of value,” he said.In April, the two committee leaders announced a work group to identify ways to encourage improvement of the technology. “As we focus on making our healthcare system work better for families, electronic health records could not be more important,” Murray said. “Having more and better information can make all the difference for patients, so I look forward to working with chairman Alexander and members of our Committee to strengthen our nation’s health IT infrastructure and improve quality of care and patient safety in Washington state and across the country.”
This month, in the meeting with Kibbe and Black, Alexander said, “The electronic systems at both (of my) hospitals don’t talk to each other. My usual hospital says it will charge Vanderbilt a huge fee to send my electronic records. My usual hospital says it can’t share them for privacy reasons. Or, my usual hospital won’t send them because they cite concerns about data security.”According to Healthcare IT News, Alexander said he wants to finish what was started in Stage 1 before moving on to the final stage, which requires providers to send electronic summaries for 50 percent of patients they refer to other providers, receive summaries for 40 percent of patients that are referred to them and reconcile past patient data with current reports for 80 percent of such patients.Even as healthcare’s constituents become more involved and more vocal — part of the conversation to help Congress bring details of healthcare’s inner workings to life — the benefit to these meetings and testimony is not that they are actually leading to any actionable solutions, but that they are actually happening at all, and they are generating interest from both parties, as well as a few headlines that help drive the conversation further.