Senate Hearing Debates Meaningful Use, Lack of EHR Interoperability

A panel of health IT stakeholders, including AHIMA Past President Angela Kennedy, EdD, MBA, RHIA, testified on Capitol Hill Tuesday morning about the progress and challenges that remain in electronic health record (EHR) interoperability.

During the hearing, titled “America’s Health IT Transformation: Translating the Promise of Electronic Health Records Into Better Care,” which was convened by the Senate Committee on Health, Education, Labor, and Pensions (HELP), panelists represented the full spectrum of stakeholders trying to move the US healthcare system towards a more electronic and interoperable environment.

Committee Chairman Sen. Lamar Alexander (R-TN) noted that Tuesday’s hearing was the first HELP committee hearing on health IT since the HITECH Act was passed in 2009, and questioned how successful the “meaningful use” EHR Incentive Program has been in promoting health IT adoption.

Alexander pointed to a study that found half of physicians haven’t met meaningful use requirements and face penalties. He also cited a Medical Economics survey reporting that 70 percent of physicians don’t think their EHR investment has been worth it. Alexander questioned whether the federal government should be “enablers rather than mandaters” when it comes to enforcing meaningful use requirements.

Robert L. Wergin, MD, president of the American Academy of Family Physicians (AAFP), testified that in general family physicians were early adopters of health IT and continue to be excited about medical homes, EHRs, and telemedicine.

“Physicians welcome those changes,” Wergin said. “There’s still room for improvement. Regulatory burdens are interfering with doctor-patient relationships. Payment structure does not fully support coordinated care.”

Wergin, who has a small rural medical practice in Milford, NE, describes his practice’s transition to EHRs as “not pretty,” having met stage 1 of meaningful use criteria at the very last minute. He experienced a loss in patient volume during the implementation. And although it has improved, that volume hasn’t returned to pre-EHR implementation levels, he said. However, he reported that productivity has improved since the initial implementation.

Wergin recommended several changes to the meaningful use program, such as:

  • Overhauling documentation requirements
  • Providing relief from regulatory burdens, such as shortening the attestation reporting period from a year to 90 days (which the Centers for Medicare and Medicaid Services is considering)
  • Delaying penalties on providers unable to meet all of the criteria

 

Sen. Sheldon Whitehouse (D-RI) agreed that it’s time for meaningful use to get a “reboot.”

“We need a reboot of meaningful use [due to the] failure to include behavioral health and nursing homes,” Whitehouse said. “If you’re looking at the expensive people, it’s people rotating through nursing homes. If you don’t require them to meet meaningful use, you’ve made a tactical error.

“When you cut out behavioral health [from meaningful use], the behavioral health provider becomes a medical home.”

In her remarks, Kennedy shared her own experiences of trying to piece together the health records of her adopted daughter, Grace, who was misdiagnosed with allergies for years. Kennedy explained that Grace was properly diagnosed with cystic fibrosis after she uncovered copy and paste errors in her daughter’s old medical records. Kennedy also raised a call for widespread adoption of information governance in healthcare.

“If we continue with a narrow focus on technology and without a focus on information governance processes and principles, the US will continue to experience daunting challenges related to health information exchange and sharing, patient identification, and privacy/security,” Kennedy said in written remarks. “Patients will continue to be at a disadvantage in trying to manage their health without appropriate, trusted information.”

Other panelists included Julia Adler-Milstein, PhD, an assistant professor of information, health management, and public health at the University of Michigan, and Peter DeVault, director of interoperability at Epic Systems Corporation.

Click here to view a webcast of the hearing and to read the written statements of each panelist.

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